Blepharitis: causes, symptoms and therapies

Itching, burning and swelling: these are just some of the symptoms of blepharitis. Here are the causes of this eyelid disorder.

Blepharitis is a disorder that affects the eyes characterized by inflammation of the eyelid margin.

It can affect anyone, regardless of age, gender or ethnicity, but it is more common in people over the age of 50.

At its base there may be several factors that, combining with each other, trigger irritation at the level of the eyelids, such as:

Blepharitis can occur in an acute form, but in most cases it has to do with chronic inflammation characterized by phases of remission and phases of exacerbation; The symptoms may improve, but it is rare that you can find a real cure that allows the healing of a chronic form.

This pathology can also be classified according to its localization; In fact, there is anterior or posterior blepharitis.

Anterior blepharitis mainly affects:

  • the skin
  • eyelashes
  • the ciliary follicles.

Posterior blepharitis involves:

  • the meibomian glands (structures that produce sebum and secrete it through small holes located right on the eyelid margin) and their orifices
  • the fibrous part of the eyelid edge
  • the point of passage between the eyelid and the conjunctiva (the transparent membrane that lines the inner part of the eyelids and the front surface of the eye).

Finally, acute blepharitis can be ulcerative or non-ulcerative.

The causes of blepharitis

Often blepharitis is associated with systemic diseases, such as acne rosacea, atopic dermatitis and seborrheic dermatitis; According to some hypotheses it could also be favored by the presence of diabetes, but opinions in this regard are discordant.

It can also be associated with eye diseases, such as:

  • an infection
  • a chalazion
  • conjunctivitis
  • a keratitis
  • dry eye syndrome
  • uncorrected vision problems (such as farsightedness and astigmatism).

Infections are responsible for ulcerative blepharitis; generally it is caused by bacteria (in most cases staphylococcus), but there are also viral forms, such as those associated with Herpes simplex or the Varicella zoster virus.

More generally, staphylococcus is considered one of the main causes of anterior blepharitis, along with forms of seborrheic dermatitis affecting the skin of the head and face and acne rosacea.

Non-ulcerative blepharitis is generally due to an allergic reaction (contact or seasonal), while posterior blepharitis is caused by dysfunction in the meibomian glands. In fact, it can happen that a meibomian gland produces quantities of sebum higher than normal, ending up clogging; Often this phenomenon is associated with acne rosacea, but it is suspected that hormonal factors may also come into play.

The result is an alteration in the functionality of the meibomian gland, which produces a secretion with a waxier consistency that, stagnating, can become fertile ground for the growth of bacteria and can infiltrate deeper tissues, causing inflammation and promoting the formation of a stye or chalazion.

Finally, both anterior and posterior blepharitis can be caused by the Demodex mite. The role of this parasite has not yet been well clarified as some people are carriers without showing any symptoms.

However, it seems that Demodex folliculorum may be associated with anterior blepharitis and Demodex brevis with posterior blepharitis.

Finally, blepharitis can also be associated with:

  • Molluscum contagiosum (a virus that triggers skin lesions)
  • the parasite Phthiriasis palpebrarum
  • Sjögren’s syndrome (a chronic systemic inflammatory disease)
  • reactions to drugs or chemicals such as those found in some cosmetics (especially acute forms)
  • exposure to chemical fumes, tobacco smoke, smog and other irritants (especially chronic forms).

Symptoms

Blepharitis is characterized by:

  • symptoms of eye irritation (itching, swelling, burning, tearing, foreign body sensation in the eye)
  • eyelid erythema
  • formation of scales on the margins of the eyelids
  • alterations of eyelashes.

In addition, the following may appear:

  • crusts on the eyelashes
  • redness in eyelids and eyes
  • photophobia (sensitivity to light)
  • pain
  • reduced vision and other changes in vision.

The symptoms of anterior blepharitis mainly involve the eyelashes, which may be covered by:

  • scales (usually associated with seborrheic dermatitis)
  • collars (irregular material surrounding the lash shaft associated with staph infections)
  • fibrin crusts (associated with the formation of ulcers at the base of the eyelashes)
  • fatty crusts adhering to the shaft of the eyelashes (typical of seborrheic dermatitis).

Other times, the eyelashes can be wrapped in smooth material even at the level of their base (associated with the presence of Demodex).

The forms of blepharitis associated with seborrheic dermatitis can also present with itchy scalp, flaking and oily skin.

Acne rosacea can instead be associated with swelling and redness of the nose, reddened face, alteration of the blood vessels of the face (telangiectasias, especially on the cheeks and at the level of the eyelid margins), pustules, oily skin, etc.

Finally, the forms triggered by a herpes can be associated with erythema and vesicles.

In most cases, the symptoms of blepharitis appear intermittently, alternating periods of exacerbation with phases in which the disorders fall asleep.

Diagnosis and complications

Diagnosis is based on examination of the eye and can be used by the use of special lamps (biomicroscopes) with which it is possible to detect additional symptoms, such as:

  • loss of eyelashes or abnormalities in their direction (trichiasis)
  • scarring on the eyelids
  • presence of ulcers or telangiectasias on the eyelid margin or other irregularities of the eyelids (thylosis)
  • fillings of the orifices of a meibomian gland.

The conjunctiva may also appear altered: conjunctivitis (as well as keratitis, entropion and ectropion, or reversals of the eyelid margin, respectively, inwards or outwards) are to be included among the possible complications associated with blepharitis.

The cornea is mainly affected in case of anterior blepharitis associated with staphylococcus and may present, for example, points of erosion, infiltration, ulcers, inflammation and thickening.

Fighting blepharitis: therapies

To counteract blepharitis it is necessary to undergo treatments for long periods of time as it is a disorder that, as already pointed out, is mostly chronic.

At the base of the treatment there is proper hygiene of the eyelid margin; Cleaning should include 3 basic steps.

1) Hot compresses to heat and fluidize the secretions of the glands in order to facilitate their elimination. You can proceed with a cloth soaked in hot water or wet and heated in the microwave, but always taking care not to expose the eye to too high temperatures. Compresses can last from 5 to 10 minutes.

2) Washing the eyelid margin to remove scales, collars or crusts and to clean the orifices of the glands. Cleaning should be carried out immediately after hot compresses using cloths, gauze or cotton buds soaked in a saline solution or solutions specially designed to cleanse the eyes. Those struggling with posterior blepharitis can also try to lightly massage the eyelid margin to promote the leakage of sebum from the obstructed meibomian gland; To do this you can use a cotton swab or a finger, proceeding with circular movements. In any case, it is good to proceed gently, focusing on the eyelid margin without rubbing the skin of the eyelid or conjunctiva.

3) Application of antibiotic-based ointments. Topical antibiotics are necessary in all cases of acute blepharitis and in case of anterior blepharitis; Generally, the treatment, to be limited to the eyelid margin, lasts from 2 to 8 weeks. Any treatments based on a combination of antibiotics and corticosteroids are instead indicated only for short-term treatments and under strict medical supervision, as there is a risk of the appearance of cortisone-induced glaucoma or cataracts.

Cleaning should be carried out 2 to 4 times a day; In addition, for chronic forms it is necessary to always pay attention to proper eye hygiene even in periods of remission, in order to counteract the reappearance of symptoms.

Cases of blepharitis that tend not to resolve (especially forms of posterior blepharitis) may require oral antibiotics.

Appropriate antibiotic therapies can be useful against the most severe forms and against those associated with acne rosacea; They can also help reduce bacterial colonization and glandular dysfunction.

Alterations of the tear film can instead be addressed with artificial tears or similar products, or with the surgical closure of the tear holes; Any associated viral or bacterial infections, if confirmed by laboratory analysis, can be treated with specific antimicrobials.

Seborrheic dermatitis may improve with the use of selenium shampoos (which should not be used in the eye area), while allergic dermatitis may respond well to the application of topical corticosteroids or other specific therapies.

The application of antibiotics and corticosteroids can also help significantly reduce inflammation and symptoms of conjunctivitis; Used in the form of eye drops can also help treat corneal problems.

Trichiasis can instead be addressed with epilation or destruction of ciliary follicles by electrocoagulation, laser therapy, cryotherapy or surgery, which may also be necessary to correct an entropion or ectropion or in the presence of a chalazion or corneal problems.

Finally, the ophthalmologist may advise against the use of contact lenses especially in case of infectious blepharitis or a dysfunction of the meibomian glands that makes the tear film not suitable for the use of contact lenses.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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