What is blepharitis?

Blepharitis literally means inflammation of the eye lids.

Our eyelids contain roughly 75 oil producing meibomian glands. These are modified versions of the oil producing glands in our skin. These glands are responsible for producing the oily layer of our tear film. This oily layer acts to stop our tears from evaporating quickly and causing the eye to become dry.

In blepharitis the chemical make-up of the oil produced in these glands has a higher than normal melting point. Meaning the oil is more solid than normal. This makes the glands prone to blocking. When a meibomian gland is blocked it cannot pump oil in to the tears meaning the tear film evaporates more quickly.

The blocked glands are also an ideal environment for bacteria to grow. These bacteria feed on the accumulated oil breaking it down in to acidic bacterial waste products. This accumulates within the tear film, within the gland and along the lid. This alters the osmolarity (salt concentration) and pH (acid balance) of the tears. These changes induce cell damage and inflammation both on the surface of the eye and along the lid. This damage can be repaired by the body but are a source of discomfort (burning and stinging), redness (of the lid and white of the eye) and annoyance (blurry vision and watery eyes).

Blepharitis is extremely common. Some studies have shown the prevalence as high as 47% of the population. It becomes more common with age and is somewhat more common in women. It varies substantially in severity with many people noticing few effects from it but others suffering severe discomfort as a result.

Currently there is no cure for blepharitis but the symptoms and inflammation can be effectively managed. Many people experience extended periods where they notice no symptoms interspersed with flare ups where they become more symptomatic.

Management of Blepharitis

The traditional approach has been to perform a combination of hot compresses and lid cleaning at home. This approach is useful for early disease and maintaining the condition but is difficult to perform correctly and is time consuming.

The last 3- 4 years has seen an explosion in the management options available to treat blepharitis. During that time we have amassed considerable experience with these new options.

One treatment which has proved particularly successful is the Bleph Ex. It involves using a small hand held device with a rotating micro sponge to remove scurf and bacterial debris which build up along the lid margin and cause a large proportion of the symptoms in blepharitis.

We have found that Bleph Ex is particularly good when used in conjunction with manual expression of the oil from the blocked glands under topical anaesthetic. Performed correctly this combination is as effective as months of home treatment.  Many patients that receive a Bleph Ex treatment report many months worth of relief from their blepharitis symptoms.  The Bleph Ex procedure can then be repeated if symptoms reoccur.

Another new treatment option is Intense Pulse Light (IPL) treatment.  We utilize the Lumenis Optima M22 IPL in our practice and have found it to be a real game changer.  IPL treatment works by providing a carefully controlled dual pulse of broad spectrum light to the tissue surrounding the eyelid.  This treatment works by helping to close the abnormal blood vessels that develop as part of the inflammatory reaction that occurs in blepharitis.  Reducing the inflammation is key to effective control of the condition.  In addition the light stimulates the oil producing cells in the meibomian glands which allows them to produce better quality meibum and therefore treating the condition at its root.  We recommend a course of 4 treatments spaced 2-3 weeks apart.  This has been shown to significantly reduce symptoms in 90% of patients for up to 12 months.

Both Bleph Ex and IPL are complementary treatments meaning that when combined they deliver an additive treatment effect.

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