Eyelashes, skin glands and the conjunctiva (a mucous membrane) meetat the front of the eyelid. Inflammation of these tissues leads to anterior (anterior) and/or posterior (posterior) eyelid margin inflammation (blepharitis). Depending on whether the inflammation affects the anterior edge of the eyelid (row of eyelashes) or the posterior edge of the eyelid. The latter lies against the eyeball and contains the meibomian glands.
Anterior blepharitis is associated with the formation of scales and crusts around the eyelashes and is also known as squamous (scaly) eyelid inflammation.
Posterior blepharitis is caused by a malfunction of the meibomian glands. It is called seborrheic blepharitis (seborrhea = increased sebum production) or meibomian gland dysfunction (MDD). The conjunctiva is also involved in blepharoconjunctivitis.
Blepharitis on the anterior lid margin is caused by disorders of the local skin flora and bacterial colonization of the base of the eyelashes with staphylococci.
The staphylococcal toxins are responsible for the inflammation of the eyelid margin. Crusts and scales on the base of the eyelashes and small abscesses/furuncles are typical of a staphylococcal infection.
Patients who suffer from neurodermatitis, acne and rosacea often also have eyelid margin inflammation. In cooperation with a dermatologist, you should clarify whether a systemic skin disease is present.
Posterior eyelid margin inflammation is caused by a secretory disorder of the meibomian glands. Recent studies have shown that meibomian glanddysfunction is also present in over 75 percent of dry eyes.
The 30 meibomian glands lie perpendicular to the edge of the eyelid on the inside of the lower and upper eyelid and open on the edge of the eyelid. The thickened secretions are sometimes recognizable as yellowish plugs.
In principle, the same pathology occurs in the meibomian glands as in the sebaceous glands of the skin: secretion disorders and inflammation occur quite frequently.
If the melting point of the meibomian lipids is too high, the tears receive too little oil: the tears evaporate more than normal, resulting in an evaporative form of dry eye.
Paradoxically, the eye then waters slightly, although the cause is dry eye. In this case, the lipid layer of the tear film is missing. A backlog occurs in the meibomian gland ducts. The lipids are diverted into the surrounding inner eyelid tissue. This can lead to a foreign body reaction: the formation of a chalazion.
In blepharitis, the edge of the eyelid is red and swollen.
In the case of scaly eyelid margin inflammation, patients complain of sticky and crusty eyes in the morning. During the day, they complain of burning, tearing and a feeling of pressure around the eyes.
In the case of meibomian gland dysfunction, the edge of the eyelid is red and thickened. The openings of the meibomian glands are filled with oily and thickened secretions. This secretion can be squeezed out by pressing on the edge of the eyelid. Small yellowish shimmering plugs/beads of glandular secretion are often visible on the edge of the eyelid. There is usually also dry eye.
Blepharitis is an inflammation of the edge of the eyelid @ ndrei310 /AdobeStock
The ophthalmologist makes the diagnosis using a slit lamp.
Diagnosis of blepharitis using a slit lamp @ andrey /AdobeStock
The treatment of both scaly and seborrheic eyelid margin inflammation consists of performing eyelid margin hygiene.
This is carried out in three steps:
- Applymoist warm compresses with 40 to 45 degree warm water to the eyes (principle of the fango pack). This liquefies the thickened secretions.
- Massage the edges of the eyelids to express the glands.
- Clean scales and crusts fromthe edges of the eyelids using a special cleansing solution, eyelid care wipes or cotton buds with baby shampoo.
- Treatment of anterior eyelid margin inflammation
Scaly eyelid margin inflammation is usually chronic and occurs particularly in the colder months of the year. Local eye ointments applied to the eyelid margins overnight, such as tetracycline ointments containing cortisone, are useful.
Eye drops such as Azyter twice a day for 3 to 5 days also help well. In persistent cases, the doctor may also decide to prescribe longer courses of antibiotics: minocycline or doxycycline 50 to 100 mg per day for three months or metronidazole for three weeks are recommended.
The patient should undergo the therapy regularly, as is the case with dandruff, for example.
- Treatment of posterior eyelid margin inflammation
Lipid-containing eye drops/gels are used for meibomian gland dysfunction or seborrhoeic blepharitis.
Examples of eye drops are
- Systane ultra
- Artelac lipids
- Example of and sprays containing liposomes:
- Tears again
A nutritional-physiological therapy approach consists of administering omega-3 and omega-6 fatty acids (fish oil capsules). This changes the composition of the lipids and lowers the melting point.