Blepharitis is a very common condition causing inflammation of the eyelid margin and usually involves all four eyelids. It is difficult to manage as it tends to recur.
There are two types:
Type 1) Anterior Blepharitis where the source of inflammation is the eye lash follicles, and a dandruff like substance is often seen stuck to the lashes (Figure 1)
Type 2) Posterior Blepharitis where the inflammation is localized to the meibomian glands, important for producing an oily secretion which lubricates the eyes. See Figure 2 below with the openings of the glands on the lid margin, indicated with arrows.
Problems Caused by Blepharitis
Common symptoms include burning and a foreign body sensation in the eyes. Due to the dysfunction of the lubricating meibomian glands, the eyes often feel dry. The inflammatory debris on the eyelid margins tends to be toxic and can be very damaging to the cornea and conjunctiva. The eyes are often red, and the eyelids may be swollen. All symptoms tend to be worse in the mornings with a sticky and sore feeling common, often with discharge present.
Both a stye (Fig 3) and/or a chalazion (Fig 4), inflammatory lumps, may develop on the eyelids which may be painful and cosmetically unsightly.
Eyelid inflammation when severe and longstanding may lead to scarring of the eyelid margin. This leads to distortion of the eyelash follicle and the eyelashes start to grow in abnormal directions. Eventually some lashes may start to grow inwards, and a chronic scratching of the eyeball ensues.
Treatment
The basis of treatment is good eye hygiene.
This means cleaning your eyelids regularly (1-2 times a day, and especially before bed), removing all debris, and preventing the blockage of the gland openings. Treatment often has to be continued with various intensity long term, to prevent recurrence.
The following procedure is recommended
1. Perform eyelid cleaning after a shower when the steam will soften the secretions. Alternately place a warm compress on the eyes for about 5 minutes for the same effect.
2. Massage the eyelids in the direction of the eye lashes (upper eyelids downwards, and lower eyelids upwards) to empty the meibomian glands.
3. Wipe the lid margins and eyelashes to remove secretions and debris. Two eye products available for eyelid cleaning are Lid Care and Eyecare which are available in pharmacies in Nigeria. Some of the HMOs contribute to their cost.
In addition your eye doctor will recommend lubricating, antibiotic and anti-inflammatory drops, ointments and tablets as necessary.
