WHAT IS BLEPHARITIS?
Blepharitis is the medical term for inflammation of the eyelids. The cause is often related to a malfunction of the tiny glands located in the eyelid margins, next to the eyelashes. Normally these glands produce an oily secretion that helps lubricate the eye surface and the inside of the eyelids, preventing evaporation of tears. By patients, who suffer from blepharitis, these glands secrete an abnormal quantity of fluid, and pollute the tear, forming oily acids that irritate the ocular surface.
The eyelid margin in these cases appears swollen and red. The irritated eye produces mucus and proteins, which accumulate in the lid margin; often creating a crust that is most appreciable in the morning. The deposit of these materials provides optimal conditions for bacterial growth. Bacteria, in turn, release toxins, which irritate the eyelids further until aggravating the disease process.
Therefore, blepharitis is a "vicious circle" that includes gland eyelid dysfunction, irritation and formation of small crusting in the eyelid margin area, and bacterial infection. If the process does not stop there, there will be a progressive worsening with painful inflammation of eyelid margin, ocular surface discomfort, and even loss of vision.
The severity of blepharitis varies considerably from one individual to another. In some cases, the milder form represents only a slight nuisance, creating mild irritation occasionally. Yet, in some people, it can become a more serious illness, affecting even their vision.
The treatment of blepharitis is a combination of several of the following therapies:
One of the simplest and most effective ways to break the "vicious circle" of blepharitis is keeping the eyelid margin as clean as possible. Removing small resulting scabs will help prevent the growth of bacteria and improve the function of the eyelid glands.
The best way to keep the eyelids clean is by gently rubbing in the area where the eyelashes are located, while keeping eyes closed, with a small gauze or a cotton-tipped swab moistened and impregnated with neutral pH solution. You can use any of the solutions available in pharmacies and specially designed for the cleaning of the eyelids, or just mild neutral pH soap (commonly used in baby hygiene). The cleaning shall be performed once or twice per day depending on the severity of blepharitis.
-Tetracycline and Doxycycline. - The tetracycline is an antibiotic available since several years and doxycycline is also an antibiotic of more recent use. They are frequently used in the treatment of blepharitis, because of their direct action against bacteria and their ability to improve the secretions of the glands of the eyelid. As the glands are below the surface of the skin, this medication shall be administered orally to be effective.
Although there are various undesirable effects that may occur while taking tetracyclines, the two most common are nausea and sensitivity to sunlight exposure (anyone taking tetracycline should use sunscreen if he must be exposed to sunlight for long time). Tetracyclines should be taken on an empty stomach to be effective. Yet, these side effects are virtually nullified with doxycyclines, an antibiotic of most recent synthesis that allows obtaining similar efficacy with fewer complications.
-Artificial tears. Much of the ocular discomfort of blepharitis is caused by irritants and toxins found in the tear film, secreted by bacteria or lid margin glands. Regular washing of the ocular surface with artificial tears can minimize the deleterious effects of these toxins. There are a number of these products available on the market. They can be classified basically into two groups:
1. Artificial tears with preservatives. They contain chemicals that prevent the growth of bacteria (preservatives). They have the advantage that they can be used, covered, and used again. Unfortunately, many of these preservatives can irritate the ocular surface. Some people are allergic to them and even some may develop severe reactions when used for long periods of time.
2. Preservative-free artificial tears. Since they contain no preservatives, they are much less likely to irritate the ocular surface. The disadvantage is that they must be packaged in small quantities and have to be used immediately after opening. If they are not used soon after being opened, bacteria can grow therein and create a severe ocular infection. Preservative-free artificial tears are also more expensive.
-Topical antibiotics. Topical antibiotics (drops or ointment) are often used to treat patients with blepharitis. They act against bacteria that are part of the "vicious circle". The bacteria may become resistant to antibiotics if they are exposed to prolonged periods of time. For this reason, it is better for patients with blepharitis to use antibiotics only occasionally (for one or two weeks), under the supervision of the eye specialist.
-Steroids. Steroids are used to reduce inflammation and redness caused by irritant secretions of glands and bacteria of the eyelid. By reducing inflammation, the glands recover normal function. Steroids also reduce secretions and crusts.
Unfortunately, topical steroids can have side effects such as cataract formation or glaucoma, when used for long periods of time. Like antibiotics, steroids are usually prescribed for short periods of time in the treatment of blepharitis and always under strict control of the ophthalmologist.
Our strategy to treat blepharitis is to interrupt the "vicious circle" that causes the disease, acting on each of the points involved, combining the above treatments according to each patient. The drugs that lose their effect after a period of time (topical antibiotics) and those causing complications after prolonged use (topical steroids), are used only during the first few weeks. Tetracycline and doxycycline, administered orally, are used only in severe or recurrent cases, and doses are reduced slowly once we have obtained a good response. The cleaning of the eyelids and artificial tears are the basis of long-term treatment. They have very few complications and tend to maintain good control of blepharitis after the disease has responded to other medications. The exact dose of each medication and treatment duration will vary from patient to patient, depending on the severity, level of response and on-going control.
It is important to remember that blepharitis is a chronic disease. Many patients with blepharitis have had it for months or years before they have gone to the ophthalmologist. Like the disease itself, response to medications may also be very slow. It may take several weeks or even months of treatment, before there is a clear improvement and we must remind patients that, when it is cured, the process may start over again, hence it is a chronic disease marked by seasonal frequency: outbreaks are more common during changes of season/weather.
HOW ARE EYE DROPS INSTILLED?
Tilt your head back, pull the lower lid down and apply a drop without touching the eye.
HOW IS AN OINTMENT APPLIED?
Tilt your head back, pull the lower lid down and place a little ointment "as a grain of rice." The first portion should be discarded each time the tube is opened.