Blepharitis / Meibomian Gland Dysfunction

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Blepharitis/Meibomianitis is a longstanding Inflammation of the eyelids (especially the glands of the eyelid margins) which may cause redness, crusting, irritation, burning and itching of the eyelid margins and may cause red irritated eyes. It is commonly associated with skin conditions such as Rosacea (adult acne).

The eyelids contain sebaceous glands (like the oil producing glands of the skin that are involved in acne) and an abnormality in these glands is usually the problem.

Abnormally thickened secretions lead to blockage of the glands and overgrowth of bacteria which cause the irritation. Occasionally, inflamed eyelid cysts (chalazia) form.

As well as this, there is a deficiency of the normal, thin oily secretions which lubricate the ocular surface. This gives rise to feelings of grittiness, burning and dryness.

HOW IS BLEPHARITIS TREATED?

Treatment may take 4 to 6 weeks to work and will need to continue long term, though with less frequency.

Lid Margin Hygiene is necessary. The following regimen is useful - do it every morning initially:
Hold a hot wet facewasher on the closed eyes for 1 minute. Repeat this. Express the secretions from the glands at the edge of the eyelids (behind the eyelashes) by pressing firmly and directly with a finger on the closed eyelid margins (see diagram next page). You should be able to feel the eyelid margins under your fingertips. A mirror may be helpful to do this. You will not be able to feel or see any secretions coming out of the glands. Scrub away any crusting or secretions with the facewasher.
If the main symptom is a gritty sensation then the frequent use of simple lubricants (e.g. Systane, Genteal, or Cellufresh), will help.
Eye drops or ointments (steroids and/or antibiotics) may sometimes be prescribed.
Occasionally a long course of low dose antibiotic (Tetracycline, Doryx) tablets may be prescribed, particularly if Rosacea is present. Supplementation with Fish oil (Omega 3) 1gram per day may also be helpful.

Diagram 1. Lid Margin Hygiene Using your finger, push directly against the eyelid margins to compress the oil glands (between the finger and the eyeball).