Blepharitis - Specialists and Information

At the front of the eyelid margin, the eyelashes, skin glands, and the conjunctiva (a mucous membrane) meet. Inflammation of these tissues leads to anterior (front) and/or posterior (back) blepharitis. This depends on whether the inflammation affects the anterior eyelid margin (row of eyelashes) or the posterior eyelid margin. The latter is adjacent to the eyeball and contains the Meibomian glands.

Anterior blepharitis is associated with flaking and crusting around the eyelashes and is also called squamous (scaly) blepharitis.

Posterior blepharitis involves a dysfunction of the Meibomian glands. It is called seborrheic blepharitis (seborrhea = increased sebum production) or Meibomian gland dysfunction (MGD). In blepharoconjunctivitis, the conjunctiva is also affected.

Blepharitis affecting the front of the eyelid margin is caused by disturbances in the local skin flora and by bacterial colonization of the eyelash roots with staphylococci.

Staphylococcal toxins are responsible for the inflammation of the eyelid margins. Typical signs of a staphylococcal infection include crusts and flakes at the base of the eyelashes and small abscesses or boils.

Patients who suffer from atopic dermatitis, acne, or rosacea often also experience inflammation of the eyelid margins. You should consult with a dermatologist to determine whether a systemic skin disease is present.

Posterior blepharitis involves a secretory disorder of the Meibomian glands. Recent studies show that Meibomian gland dysfunction is present in over 75 percent of cases of dry eye.

The 30 Meibomian glands are located perpendicular to the eyelid margin on the inner side of the upper and lower eyelids and open onto the eyelid margin. The thickened secretions are sometimes visible 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 are quite common.

If the melting point of the Meibomian lipids is too high, the tears receive too little oil: the tears evaporate more rapidly than normal, resulting in an evaporative form of dry eye.

Paradoxically, the eye then tends to water slightly, even though the underlying cause is dry eye. Here, the lipid layer of the tear film is missing. A backup occurs in the Meibomian gland ducts. The lipids are diverted into the surrounding inner eyelid margin tissue. This can lead to a foreign body reaction: the formation of a chalazion.

In blepharitis, the eyelid margin is red and swollen.

In cases of scaly blepharitis, patients complain of sticky and crusty eyes in the morning. During the day, they experience a burning sensation, tearing, and a feeling of pressure around the eyes.

In cases of meibomian gland dysfunction, the eyelid margin is red and thickened. The openings of the Meibomian glands are filled with an oily, thickened secretion. This secretion can be squeezed out by applying pressure to the eyelid margin. Small, yellowish, shimmering plugs or beads of glandular secretion are often visible on the eyelid margin. Dry eye is also usually present.

Blepharitis is an inflammation of the eyelid margin @ ndrei310 /AdobeStock

The ophthalmologist makes the diagnosis using a slit lamp.

Diagnosis of blepharitis using a slit lamp @ andrey /AdobeStock

Treatment for both scaly and seborrheic inflammation of the eyelid margins involves maintaining eyelid hygiene.

This is carried out in three steps:

1. Apply warm, moist compresses with water at 40 to 45 degrees to the eyes (similar to a mud pack). This helps liquefy the thickened secretions.
2. Massage the eyelid margins to express the glands.
3. Cleaning the eyelid margins of flakes and crusts using a special cleansing solution, eyelid care wipes, or cotton swabs with baby shampoo.

• Treatment of anterior blepharitis

Scaly eyelid margin inflammation is usually chronic and occurs particularly during the colder months. Applying topical eye ointments to the eyelid margins overnight—such as tetracycline ointments containing cortisone—is recommended.

Eye drops such as Azyter, used twice daily for 3 to 5 days, are also effective. In stubborn cases, the doctor may also prescribe longer courses of antibiotics: minocycline or doxycycline at 50 to 100 mg per day for three months, or metronidazole for three weeks, are recommended.

The patient should follow the treatment regimen regularly, just as they would, for example, with dandruff.

• Treatment of Posterior Eyelid Margin Inflammation

Lipid-containing eye drops or gels are used to treat Meibomian gland dysfunction or seborrheic blepharitis. 

Examples of eye drops include:

• Systane Ultra
• Artelac Lipids 
• Examples of liposome-containing sprays:
• Tears Again

A nutritional therapy approach involves the administration of omega-3 and omega-6 fatty acids (fish oil capsules). This alters the composition of the lipids and lowers the melting point.