Dr. John Burroughs is an ophthalmologist that has limited his practice to the subspecialty of oculofacial plastic and reconstructive surgery. Many of his patients have blepharitis, which is inflammation of the eyelid margin. Anatomically there are anterior and posterior forms, which may co-exist anywhere along the eyelid margin or angle of eyes (angular). Blepharitis can be associated with atopy (allergic issues), infectious (herpetic, bacterial, molluscum, lice, demodex), seborrheic, and rosacea. Bacteria present on the skin often play a role in its severity. Conservative treatment has included daily eyelid hygiene with warm wet compresses to the eyelids sometimes with diluted baby shampoo to clean the eyelid margin and debris build-up along the lashes. Some patients need to use nightly antibiotic eye ointment with or without a steroid for periods of time to help improve. Approximately 50% of patients with blepharitis also have dry eyes and blepharitis can worsen dry eyes because it can impact the lipid (fatty) concentration in the tear film.
Besides the mentioned treatments, some patients benefit by adding diluted tea tree oil onto warm compresses. The tea tree oil has anti-infective and anti-inflammatory properties. There are also over-the-counter commercial eyelid wipes that can be purchased. A new addition is “i-lid” cleanser, which contains hypochlorous acid that has been found safe for twice daily use in both children and adults. Fortuantely, this product is also available over-the-counter. There are also mechanical eyelid heating devices that can help loosen the oily eyelid secretions to unblock the oil ducts.
As shown in the pictures below this can be a very uncomfortable problem causing severe dry eyes, red/painful eyes, eye discharge, eyelid mattering (“sleep”), infections, tearing, styes, chalazia, and blurring of vision. Sometimes it can get so severe patients develop ulcerations of the eyelid margin. It is fortunate ophthalmologists are getting more tools to treat this very common condition, which is present in up to 1/3 of patients seeking care from eye doctors. Rarely, surgery to restore eyelids to their normal anatomic positions and function can help reduce blepharitis and its associated symptoms. Blepharitis should be managed prior to cataract surgery to help reduce the risk of sight-threatening postop intraocular eye infections.
