About Dry Eyes, Blepharitis and Ocular Rosacea

What is Blepharitis?

Blepharitis is a very common disorder of the eyelids. There are tiny oil glands in the eyelids that have small openings just behind the eyelashes along the edge of our eyelids. These glands are important because they produce oil that moisturizes the eyes and prevents our tears from evaporating too quickly. Sometimes, the oil can be very thick and plug the openings. This can lead to trapping bacteria, which naturally live on our skin, in the glands. This leads to a chronic infection of the eyelids, with redness and crusty discharge especially in the morning. When a gland becomes completely plugged, a pustule or stye can form.

What is Ocular Rosacea?

Rosacea is a facial skin condition that can cause adult acne and blepharitis. The same process of blocked oil glands in the lids can affect the skin of the entire face, leading to redness and pustule or pimple formation. Exposure to sunlight, drinking excess alcohol, or caffeinated beverages, eating a lot of greasy foods can all be factors in making this condition worse. These factors should be limited or completely avoided. When rosacea affects the eyes, it is called ocular rosacea. Blepharitis and dryness of the eyes can be very severe with this condition.

What are the symptoms of blepharitis?

Common symptoms of blepharitis are redness of the eyelids and eyes, crusty discharge along the eyelids and sometimes "dandruff" of the eyelids, burning tears and dry eyes. Sometimes the blepharitis can lead to styes along the eyelids, which can come back every so often. Serious blepharitis can occasionally cause ulcers on the part of the eye called the cornea. Symptoms of a corneal ulcer are decreased vision, pain, marked redness of the eye and tearing or mucous discharge.

How is blepharitis cured?

Unfortunately, it is a chronic condition for which there is no cure. However, early diagnosis and proper regular treatment is key to controlling the symptoms and making sure it does not get any worse.

How is blepharitis treated?

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1. Regular lid hygiene is the best method of making sure blepharitis is kept under control. You will need to do this for several weeks before you notice a real improvement in your symptoms and prevent it from getting worse. This is how it is done:
   1. Apply a warm compress (a facecloth soaked in warm water), heated eye mask or a warm teabag to both closed eyes for about 5 minutes in the morning and the evening. The heat will open up the glands and prevent them from getting plugged. Do this 1-2 times per day.
   2. While applying this heat, gently massage the eyelids. This will stimulate the gland to secrete the oils.
   3. Shampoo your eyelids with either diluted baby shampoo or other products that are available over the counter at any drug store to clean the eyelids. Apply a few drops of baby shampoo to a wet facecloth, or use the lid products to rub and lather the eyelashes with your eyes closed. Rinse your eyes generously. This may be done after the warm compress. Do this 2-3 times per week, or daily when your symptoms get worse. If you have adult acne or rosacea, you can try a tea tree oil facial wash (eg. from The Body Shop), or tea tree oil diluted to about 10% concentration with water and use it to clean the eyelids (as described above) as well as the face. Tea tree oil has anti-bacterial properties that are helpful in treating rosacea and blepharitis. It is best to try a test patch on your arm before applying it to your lids. Do not continue to use it if you develop skin irritation or rash. Do not use concentrated Tea tree oil on your eyes as it can be very stingy and irritating. If you use diluted facial wash on your closed eyes, you will feel a tingling sensation on your eyes, however thorough rinsing should get rid of any ongoing irritation.
2. You may also need to use artificial tears 2-4 times per day as needed to help coat the eye so that they do not become dry and irritated.
3. A balanced diet rich in omega-3 fish oil and flax seed, and good hydration can help manage this condition as well.
4. It may be necessary to treat the infection with either topical antibiotic ointment (eg. Erythromycin or Ciloxan 0.3% ® ointment), or oral antibiotics, if the symptoms are not improving with topical therapy. If you are prescribed ointment, use it after your eyelid cleaning just before going to bed. Apply about 1/2 an inch of the ointment to the inside of the both lower eyelids. Check the section on how to apply eye ointment for helpful tips. As you sleep, the ointment will spread to the upper lids and cover most of the eyelid glands. The ointment is a bit sticky and greasy, but can be washed off in the morning. You will need to use it for one week or sometimes several weeks depending on how bad your condition is. If you need oral antibiotics, usually, doxycycline 100 mg twice daily or tetracycline 500mg twice daily is used for several weeks months for severe blepharitis or blepharitis associated with ocular rosacea. If you are pregnant, or plan to become pregnant, these medications are not suitable for you as they can cause fetal abnormalities. While on these medications, it is important to use sunscreen, since they will make your skin more sensitive to sun damage. They may not be appropriate if you are on other medications.

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