Blepharitis & Dry Eye
Blepharitis and Dry Eye
Blepharitis is a descriptive term that says you have inflammation, or "-itis", of the eyelids, the "blephs". Although the condition is very common, and the term is commonly used, the most efficient way to diagnose and treat blepharitis is to first recognize that similar symptoms can arise from multiple diseases of the eyelids. An ophthalmologist can assist you with this diagnosis and guide you in eye exam and eye surgery options.
So often, a patient is told he has a dry eye, when in fact the eye's surface is inflamed and the tear insufficiency is secondary. Any compromised component of the tear film, whether the oil layer (from the Meibomian glands) or the watery layer (from the various lacrimal glands) can cause symptoms of "dryness".
Common Symptoms Indicative of Other Problems
Speak to your eye doctor if you have one or more of these common symptoms:
- Notched lid
- Rounded lid
- Loss of lashes
- Variable vision
- Sties (Chalazia)
- Thickened lid
The aforementioned symptoms may indicate the following:
- Staph HS
- Rheumatoid Arthritis
- Grave's Disease
- Mite infections
- Rarely viral
Treatment consists of removing known allergens (either in the environment AROUND you, or in the environment ON you), suppressing inflammation in a safe way, and supplementing the missing layer of the tear film.
For environmental and seasonal allergies:
- Tears (for allergen dilution) and mast cell inhibitors (Rx and OTC)
- Cool compresses
- Rare use of steroid drops
- Referral to an allergist
For Rosacea, squamous blepharitis, meibomitis, frequent sties (chalazia):
- Lid cleanser with gentle disinfectant applied to lids and brows, with special attention to the base of the lashes with a Q-tip: Sterilid, Ocusoft Plus, or Tea Tree Oil Shampoo diluted 50:50 with water. You may also consider the use of Tea Tree Oil Shampoo and Body Wash for more severe Rosacea accompanied by scalp dandruff.
- In certain cases with lid ulcers, short term use of topical antibiotics. In certain other cases of stubborn Rosacea, tetracyclines can be used on a short-term basis.
- Surgical drainage of chalazia as needed, but this usually can be prevented with the aggressive use of warm compresses to open the blocked oil (Meibomian) gland, sometimes with oral and topical antibiotic added if need be.
For perimenopausal dry eye, Sjogren's (Sicca) Syndrome, and other dryness related to autoimmune effects on the lacrimal glands and Meibomian gland (oil) shutdown:
- Daily warm compress: 30 sec application of hot cloth to closed lids. This helps cleanse and also gets the Meibomian glands going, adding oil to the tear film.
- Lid cleanser as above, but consider every other day application. A fatty acid supplement: TheraTears Nutrition has a nice fish/flax oil combination capsule, which can be used 3X per day. Barleans Flax Oil is an excellent product, widely available in health food stores. Take 3000 mg per day (3 capsules).
- Tears, as needed. Make sure you drink enough water.
- Reasonable use of Restasis, a prescription medication that contains the anti-inflammatory cyclosporine A, in a vehicle of emulsified castor oil.
- Judicious use of milder topical steroids, short term.
- Control of any associated systemic diseases, if present, which might include a referral to a Rheumatologist (if appropriate) for diagnosis and management.
- The Meibomian glands are androgen responsive, and shut down in perimenopause due to the drop in testosterone in women. Research is ongoing to target the androgen response to help this source of dry eye. You might discuss hormone replacement therapy (with testosterone in the mix) with your doctor; but it will require ongoing care and laboratory monitoring, which is not usually covered by insurance.
- Punctal plugs (slowing down the exit of tears) can sometimes be very useful, especially in contact lens wearers whose lenses sponge up the tears.