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Charles N. S. Soparkar, M.D., Ph.D., FACS
James R. Patrinely, M.D., FACS

Blepharitis is inflammation of the eyelids. This condition may result in an unstable or oily tear film. Typical symptoms may include: excessive matter on the eyelids or in the eyes upon awakening; a gritty feeling in the eyes; a burning sensation that is worse while reading, driving, watching TV, working at the computer, or periods of concentration; blurry vision that "comes and goes"; itchy eyelids; and red and irritated eyelids.

Blepharitis is a chronic problem that may wax and wane throughout your life, typically worsening over time, if left untreated. The following treatment options should be titrated by your physician to match the degree of disease activity present in your eyelids. After your blepharitis is under control, the treatment regimen may be slowly decreased over months. You will discover how frequently you need to treat your eyelids to remain comfortable. During periods of worsening, you may need to increase your treatments. Like brushing your teeth, regular lid hygiene practices are essential for eye comfort and health.

There are two major types of blepharitis: Anterior Lid Margin Disease (ALMD) and Posterior Lid Margin Disease (PLMD). ALMD is crusting on the eyelashes due to a superficial infection by any of a number of micro-organisms. Topical antibiotics for 1-2 weeks may help to decrease the infection, but the organisms rapidly develop resistance. PLMD is a problem with the glands within the eyelids producing an irregular, thick, oily and unstable tear film to cover the front of the eye.

LID MARGIN SCRUBS - Most useful for ALMD

The purpose of lid margin scrubs is to clean the eyelashes and to mechanically remove many of the micro-organisms that are growing on the edge of the eyelid. The mites and bacteria create an irritating inflammatory reaction. Eyelid scrub pads (many brands) are available in most grocery stores and pharmacies. These work fine. With your eyelids closed, rub the eyelashes and lid margins back and forth horizontally. Perform scrubs 1 - 2 times a day.

If you wish to save money, Johnson's No Tears Baby Shampoo can be used. Dilute the shampoo with warm water. There are many ways to do this. One option: put a drop or two of shampoo in the bottle cap, fill the rest of the cap with warm water, and then stir with your finger. Put some diluted shampoo on your finger, on a face cloth, or on a Q-tip and rub your eyelashes and lid margins back and forth with your eyes closed. Then rinse away the shampoo. This may be performed while in the shower.

HOT COMPRESSES - Most useful for PLMD

The purpose of hot compresses is to open up the pores at the ends of the ducts that drain the glands in the eyelids and to help melt the oil that is stuck within the glands. Hot compresses are hot soaks over your eyes with your eyelids closed. The best way to perform at least one of your hot compresses each day is to do so while in the shower. Turn the water temperature up just a little bit, place your hand over your nose and mouth, so you can breathe, turn your face up toward the water stream, and let your eyes soak for 2-5 minutes (perhaps while your hair conditioner is working). The remainder of your hot compresses may be performed with two cups of raw rice placed in a clean cotton sock with the end tied off. Heat the rice-sock in a microwave (duration depends upon the power of the microwave). After warming, place the rice-sock in a plastic bag over a damp paper towel or a thin facecloth soaked in hot water. This is a great hot compress that will last about 10 minutes and can be performed 2-4 times each day.

LID MASSAGES - Most useful for PLMD

The purpose of lid massages is to milk the thick and irritating oils out of the eyelid and into the tear film. Lid massages should be performed directly following hot compresses. After lid massages, you may wish to rinse your eyes with an Eye Rinse (many brands are available --- Eye Stream and Dacriose are two brands) to wash away the oil film.

Lid Massages are done with the eyelids closed and massaging the eyelids vertically toward the eyelashes. The upper eyelids are massaged downward, and the lower eyelids are massaged upward. It is easier to massage the upper eyelids, and in general, since there are more glands in the upper eyelids, this is the more important eyelid to massage, but both should be done.

OILS - Most useful for PLMD, but also helps with ALMD

Flaxseed oil (with or without Omega 3 oils) can be very helpful taken by mouth. Capsule formulations are not as reliably absorbed and taking the oils straight is better. The oils may be blended into a shake, taken straight, or made into salad dressing with vinegar and mustard. They should not be cooked. One to two tablespoons a day of flaxseed oil (with or without 1 - 2 tablespoons of omega 3 oils) should be taken around the same time as a sulfonated protein. Some good sources of such protein are peanut butter, soy, turkey, and eggs. These proteins greatly enhance the absorption of these oils. Be sure your omega 3 oil is tested for and free of mercury.

Originally published in Benign Essential Blepharospasm Research Foundation Newsletter, Volume 28, Number 5, page 4 (2009)

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