By Dr. Jean E. Keamy
One of the most common complaints is red, irritated eyelids. Often the lids are itchy, red, scaly and sore. In addition, the eyes can become red, heavy and teary. Most often the cause of these symptoms is blepharitis. Blepharitis is not an infection. It should not be confused with conjunctivitis.
There are two types of blepharitis: anterior blepharitis and posterior blepharitis. Often patients have both anterior and posterior blepharitis.
Anterior blepharitis involves the glands at the base of the lashes. These glands become irritated by bacteria that proliferate and cause flaking of the skin, irritation, inflammation and redness.
Posterior blepharitis affects the sebaceous glands called meibomian glands on the lids. The meibomian glands become clogged with oils and can cause crusting and thickening of the lid margin. When the oil glands do not release the oil, the tear film is compromised. Without oil, the watery tears evaporate quickly. This causes dry eyes symptoms of redness, irritation, pain, fatigue and foreign body sensation.
Blepharitis will wax and wane with the seasons. Effective treatment may involve one or all of the options available. Warm compresses to the eyelids are the mainstay of treatment.
I recommend that patients take a warm wet cloth and microwave it. It should not be so hot that it burns the skin. One must test it first and then place it on eyes while closed for 5-10 minutes one- to- two times a day. If the temperature decreases too quickly, a hot potato or rice bag can be wrapped in the towel before microwaving.
Another option is commercial tranquil eye goggles with reusable heating pads. Commercial scrubs like steri lid scrub or ocusoft lid scrub can be used daily. A topical antibiotic ointment or combination antibiotic with steroid ointment may be used. Oral fish oil or flax seed supplements (2000 mg daily) can help the meibomian glands release their oil.
In non-responsive cases, an oral antibiotic doxycycline can be used to decrease inflammation in all the eyelid glands. Blepharitis usually requires maintenance therapy indefinitely to keep it well controlled.
Dr. Jean Keamy is a board certified ophthalmologist specializing in cataract surgery, glaucoma detection, refractive surgery, eyelid surgery and diseases of the eye. She owns Keamy Eye & Laser Centre on 24 Lyman St. in Westborough and can be reached at 508-836-8733. Archives of articles from previous issues can be read at www.fiftyplusadvocate.com.
