Blepharitis

UNDERSTANDING BLEPHARITIS AND ROSACEA – THE BASICS

WHAT IS BLEPHARITIS?

Blepharitis is a common and persistent inflammation of the eyelids. Symptoms include irritation, itching and occasionally, a red eye.

This condition frequently occurs in people who have a tendency towards oily skin, dandruff, or dry eyes. Blepharitis can begin in early childhood, producing granulated eyelids, and continue throughout life as a chronic condition, or develop later in life.

Bacteria reside on the surface of everyone’s skin, but in certain individuals they thrive in the skin at the base of the eyelashes. The resulting irritation, sometimes associated with over-activity of the nearby oil glands, causes dandruff-like scales and particles to form along the lashes and lid margins.

In blepharitis, both the upper and lower eyelids become coated with oily debris and bacteria near the base of the eyelashes. The eye feels irritated and may become inflamed. Regular, thorough cleansing of the lid margin helps control blepharitis.

Sometimes the scaling or bacteria produce only minor irritation and itching, but in some they may cause redness, stinging or burning. Some people may develop an allergy to the scales or to the bacteria which surround them. This can lead to a moreserious complication, inflammation of the eye tissues, particularly the cornea (the clear front window of the eye).

HOW IS BLEPHARITIS TREATED?

Blepharitis is a condition that may not be cured, but it can be controlled with a few simple daily measures:

• Twice a day, wet a washcloth with comfortably warm water, wring it out, and place it over the closed eyelids for a minute. Rewet as it cools, two or three times. This will soften and loosen the scales and debris. More importantly, it helps liquefy the oily secretions from the eyelids’ oil glands which help prevent the development of a chalazion, an inflamed lump in an eyelid oil gland.
• Close your eyes and press the eyelids firmly against the eyeball to force the oily secretions out of the blocked oil gland.
• With your finger covered with a thin washcloth, cotton swab, or commercial lint-free pad, gently scrub the base of the lashes about 15 seconds per lid.

Simple, daily hygienic measures will minimize the following additional medications that might be needed to control blepharitis and it’s symptoms:

• Artificial tears may be used to relieve symptoms of dry eye. (These are drops that are available without a prescription).
• Steroids may be used short-term to decrease inflammation.
• Antibiotics may be used to decrease the bacterial content of the eyelids.
• Minocycline or Doxycycline orally is highly effective at reducing the bacterial infection of the oil glands. This treatment will improve comfort and decrease redness of the eyes. Both medications may cause heartburn, diarrhea or constipation. Vaginal yeast infections may occur. Daily ingestion of active culture yogurt or acidophilus may lessen the occurrence of these problems. Some people may sunburn more easily, so be cautious your first time in the sun. Dizziness rarely occurs. If you become dizzy, stop the pill and call the office.
• TheraTears Nutrition, a combination of flaxseed and omega 3 oils, plus vitamins, may be a useful oral supplement to treat blepharitis and dry eyes.

Medications alone are not sufficient; the application of warmth and detailed cleansing of the lashes daily is key to controlling blepharitis.

WHAT IS ROSACEA?

Many patients with blepharitis also have acne rosacea. Rosacea is a relatively common, chronic skin disorder believed to affect up to 13 million Americans. Its classic symptoms are patchy flushing (redness) and inflammation, particularly on the cheeks, nose forehead, and around the mouth. It typically appears between the ages of 30 and 50 and affects more women than men. Because the symptoms emerge slowly, rosacea may be mistaken, at first for sunburn, leading to a delay in treatment.

As the condition progresses, flushing becomes more persistent and noticeable. Some people also notice stinging or burning sensations in the affected areas. Small, red, solid bumps (called papules) and pus filled pimples (called pustules) may appear on the skin. Because these appear similar to acne, rosacea is sometimes called acne rosacea. However, unlike acne, there are no blackheads.

Small, dilated blood vessels (telangiectasia) may become visible, too. Often, when people with rosacea blush, the enlarged blood vessels in their faces look like thin red lines. In some cases, the eyes also may become involved – and may become red, irritated, and may burn (ocular rosacea). This may happen in up to 50% of people with rosacea.

In advanced cases, more of the face is affected. The skin swells, cysts form, and small, knobby bumps develop on the nose, making it appear red and swollen. This condition, called rhinophyma, is relatively uncommon and primarily affects men. It was the cause of the late comedian W.C. Fields’ best-known feature – his trademark bulbous nose.

Rosacea may be persistent and worsen over time, leading to permanent changes in appearance and affecting self-esteem. There can also be some permanent eye damage. There is no known cure for rosacea, but the condition is treatable. Most cases can be controlled easily by avoiding factors that trigger flushing, using sun protection, and by using medication.

WHAT CAUSES IT?

No one knows for sure what causes rosacea. Researchers have suggested several factors that may be related to its development:

A disorder of the blood vessels that causes them to swell, leading to flushing; A genetic predisposition combined with certain environmental factors that may irritate the skin; Clogging of the sebaceous gland openings with skin mites called Demodex folliculorum, which live in facial hair follicles.

Rosacea seems to affect fair-skinned people more often, though it can affect any skin type. Often several people in a family have the condition, so researchers think it may be at least partly genetic. Other factors that may be involved include vitamin-B deficiency, local infection, hydrochloric-acid (stomach acid) deficiency, infection with Helicobacter pylori, and digestive disorders. In some cases, rosacea may be associated with migraine headache, other skin disorders, and certain eye disorders, including blepharitis and keratitis.

Medically updated by Cynthia Haines MD, August 2005.

Sources: International Rosacia Foundation. Rosacia.com. American Academy of Family physicians.