Blepharitis and dry eye

Dry eye is a condition where the eyes either do not make enough tears or the tears evaporate too quickly leading to the eyes drying out and becoming inflamed and irritable. It becomes increasingly common with age especially in women. It is more common in those with connective tissue disorders, blepharitis and contact lens wearers.

Meibomian gland dysfunction is one of the major causes of a dry eye. There are about 30 to 40 glands in the upper eyelid and 20 to 30 in the lower eyelid. 

The function of these glands is to produce oil which forms a thin layer over the film of tears covering the surface of the eye preventing excessive evaporation of tears and therefore, keeping the eye well lubricated. As the eyes blink, the oil within the glands is expressed and form the outermost layer of the tear film. 

When there is reduced oil in the tear film, there is an increase in evaporation of tears resulting in a dry eye.  There are also changes to eyelid thickness and irregularities at the eyelid margins causing a dry eye.  Dry eye can be aggravated with tasks such as working on a PC, prolonged driving or working in air-conditioned environments.

The meibomian glands can get blocked leading to a stye called a meibomian cyst or a chalazion.

• Burning 
• Itching 
• Irritation or dry sensation 
• Inflamed or red eyelids 
• Uneven lid margin 
• Intermittent blurred vision

It is very important to keep your eyelids, skin and hair clean. This will help keep your blepharitis symptoms under control. Unfortunately, there is not a cure for blepharitis, but there are a number of things you can do to help control the symptoms.

Warm compresses

Wet a clean washcloth with warm water and wring it out until somewhat dry. Place the washcloth over your closed eyes for at least 1 minute. Wet the washcloth as often as needed so it stays warm. This will help loosen the flakes sticking around your eyelashes. It also helps keep nearby oil glands from clogging.

Skin and eyelid hygiene

It is very important to keep your eyelids, skin and hair clean. This keeps your blepharitis symptoms under control. Soak a clean washcloth, cotton buds or lint-free pad in baby shampoo diluted in warm water. Then use it to gently scrub the base of your eyelashes. Scrub for about 15 seconds. 

Also, wash your hair, scalp and eyebrows with an antibacterial shampoo. There are some new antiseptic sprays you can use on the skin that keep bacteria from growing too much.

Antibiotics

Your Consultant at a blepharitis clinic may prescribe an antibiotic ointment for your eyes. Squirt a small amount of ointment on a clean fingertip or a cotton swab. Gently apply the ointment to the base of your eyelashes. Do this just before bedtime or as recommended by your Consultant. You may also be prescribed an antibiotic to take orally for a 3-6 month course.

Eye drops

Artificial tears or steroid eye drops may reduce redness and swelling and dry eye. A blepharitis clinic may prescribe an antibiotic eye drop to help the meibomian glands work better.

Omega-3s (fish oil)

Some people find relief from their symptoms with omega-3 fatty acids, which may help the meibomian glands in the eyelids work better. Fatty fish like salmon or sardines also contain a high amount of omega-3s.

IPL (Intense Pulsed Light)

A blepharitis clinic may also suggest IPL treatment for dry eyes, as it is the latest pain-free and effective way to treat dry eye related to Meibomian Gland Dysfunction or MGD.  Approximately 50% of dry eye is caused by MGD.  IPL treatment has been shown to improve tear quality and improve patient-reported symptoms.