Blepharitis

What is blepharitis?

Blepharitis is an umbrella term used to describe inflammation of the eyelid margins which causes a range of symptoms including discomfort, dryness, itching, red skin, red eyes, tired eyes, and blurred vision. Blepharitis is estimated to affect 50% of people, although to varying extents. It is probably the most commonly encountered eye disease by and is linked to a number of other conditions.

How do I know if I have it?

Blepharitis is extremely common particularly as you get older or if you have other skin conditions. Typical symptoms are

  • Longstanding dry, gritty eyes
  • Tired eyes
  • Itchy skin around the eyes
  • Redness of the eye and eyelid margins (red rimmed appearance)
  • Debris & crusty eyelids especially on waking
  • Difficulty wearing contact lenses comfortably
  • Recurrent styes and cysts

Symptoms tend to come and go a little and can grumble on for years unless properly managed and will usually affect both eyes.

How do I know if I have it?

If you are experiencing any of the above symptoms over a sustained period of time, you may well have blepharitis. The only way to be sure is to be examined by one of our specialist optometrists using a high-powered, slit lamp microscope.

The eyelids and dry eye

The eyelids are integral to the health of the eye. One primary function is to keep physical items out of the eye which they do through the ultra fast blink reflex and the eye lashes which trap dirt and dust that might otherwise make its way onto the eye’s surface.

Equally important is their role in maintaining the tear film. The tear film is a very thin layer of specialised fluids that sit on the surface of the eye and have a range of functions in protecting and nourishing the eye whilst maintaining sharp and clear optical surface to give good vision.

The tears are made up 3 portions: a watery (aqueous) layer that is produced by the lacrimal gland behind the eyebrows, a sticky (mucus) layer that helps the tears stick to eyeball and an ultra thin oily (lipid) layer. The mucus and lipid layers come from glands along the eyelid margins.

The lipid layer in particular is important to maintain the stability of the tear film, this one layer is responsible for

  • Maintaining a smooth optical surface
  • Reducing evaporation
  • Stabilising the tear film
  • Enabling spreading of the tears over the eye
  • Preventing spillage
  • Preventing contamination
  • Sealing the eyelids

The vast majority of the lipids in this layer come from specialised glands called the meibomian blands along the eye lid margins. Any condition affecting eyelids will affect the production and composition of the lipids produce by the meibomian glands causing a range of problems associated with a poor tear film and dry eye.

It is unsurprising that almost every case of dry eye is in some way linked to poor functioning meibomian glands (meibomian gland dysfunction) which is a form of blepharitis.

Types of blepharitis

There are broadly 4 types of blepharitis but most people will have a combination of forms.

Each of these types results in inflamed eyelids but is managed in a different way.

Staphylococcal
This is an infective cause where the normal bacteria lvigin on the eyelids colonise more than can be sustained by the body and cause inflammation.

Seborrheic
Faulty glands in the facial skin produce excess and irritating oils that inflame the skin of the face including the eyelids.

Demodex infestation
This an infestation of a common type of mite that lives on the skin of most people

Meibomian Gland Dysfunction (MGD)
This can exist on its own but is almost always present when other types of blepharitis are present.

How can it be treated?

The key is to understand the underlying cause and treat the blepharitis accordingly. Almost all blepharitis will require regular lid hygiene measures to keep the eyelids clean and free from irritation. Particular types of blepharitis may require more intensive initial cleaning, specialist treatment or medications to resolve.

Lid hygiene service

Similar to a visit to your dental hygienist, we offer a specialist lid hygiene service to ‘deep clean’ the eyelids. This is often the first stage of any treatment programme. Using highly specialised cleaning tools such as ‘BlephEx’, our specialist optometrists clean the eyelids more completely and thoroughly than possible at home. The glands of the eye lids are unblocked and dead skin removed.

A regime of home maintenance is then recommend tailored to the severity and type of blepharitis ranging from simple washing to specialised products and medications.

Can it be cured?

Yes and no. Blepharitis can always be managed but in susceptible people it will come back if left unchecked. Imagine you had your teeth cleaned by the dentist then never brushed them, the teeth and gums would suffer after a while. In the same way, good lid hygiene is important for healthy eyes so once controlled regular quick and simple measure are usually all that is required.

What does it cost?

Given the recurring nature of blepharitis, we recommend susceptible patients become members of our Vision+ programme. This covers the costs of unlimited treatments and all other aspects of eyecare along with generous discounts on glasses and contact lenses.

Membership for lid hygiene costs from £15 per month and just £3 per month if you are already a Vision+ member.

You may choose to pay as you go and 1 eyelid deep clean visit costs £99 or just £35 for existing Vision+ members.

Find out more about Vision+ here.
What do I do now?

You must come and see one of our optometrists for a comprehensive eye exam to rule out any other potential causes of your symptoms and diagnose the form of your blepharitis. We can then arrange treatment.

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5 St. Vincent Street, Edinburgh EH3 6SW
0131 225 2235