written by Dr. William McSwain
Blepharitis is a term that describes inflammation of the oil glands in your eyelids. These oil glands produce an important component of the tear film that lubricates the surface of your eye keeping your vision clear and your eyes comfortable. In blepharitis, the oil glands become blocked by inflammatory material or become infected. The frequency of blepharitis increases with aging and is more common in patients with rosacea. Common symptoms include eyelid redness or soreness, dry eye, burning, a foreign body or “gritty” sensation, and discharge that causes the eyelids to stick together on waking in the morning. Occasionally, a blocked gland may swell in size resulting in a chalazion or become infected by bacteria resulting in a hordeolum or stye.
Lid hygiene with warm compresses and lid scrubs is the first-line treatment. If you follow this regiment 2 x daily consistently for 3-4 weeks, your symptoms should improve to the point that you only need to perform lid hygiene on an as needed basis.
- Warm compresses: Take a wash cloth and run it under warm water. Press the wash cloth against your eyelids for at least 5 minutes 2 x daily. You may have to reheat the wash cloth during this time if it cools off. The heat and moisture will open up the oil glands in your eyelids. You can also gently massage the oil glands during this time to clear any blockages.
- Lid scrubs: After doing warm compresses, gently scrub your eyelashes for 30 seconds with baby shampoo diluted in water. I recommend using Johnson’s Baby Shampoo, but any brand that will not hurt if it gets in your eyes is okay. Then rinse the shampoo out with warm water. Ocusoft Lid Scrubs can be purchased from a pharmacy without a prescription to use instead of baby shampoo.
Omega-3 fatty acids can improve the function of the oil glands in your eyelids. Consider taking a fish oil or flax seed supplement.
Combination antibiotic and steroid ointments may improve blepharitis by killing bacteria and decreasing inflammation but require a prescription. I usually prescribe either Maxitrol, Tobradex, or Blephamide ophthalmic ointment or drops to be used 2-4 times daily or at bedtime.
Doxycycline is an oral antibiotic that changes the consistency of the oil produced by the glands in your eyelids. This makes them less likely to become blocked and inflamed. It is particularly effective for rosacea. I usually prescribe a 30 day course if the above options do not work. Side effects of doxycycline include but are not limited to photosensitivity (you may sunburn more easily so avoid the beach), gastrointestinal distress, and vivid dreams. It should not be taken by children under the age of 8, women who are pregnant or breastfeeding, if you have liver disease, or if you take medications like warfarin (Coumadin) or oral contraceptives.