Blepharitis
Chat Highlights
November 20, 2002

Norma Devine, Editor

On Wednesday, November 20, 2002, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Blepharitis."

Dr. Rick Wilson:  Hello, all.

Moderator:  Good evening, Dr. Wilson.  Thank you for joining us to discuss blepharitis.  First, what is blepharitis?

Dr. Rick Wilson:  Blepharitis is a common inflammatory malady of the eyelid or eyelids.  One kind is allergic  -- when the lid is exposed to an antigen the patient is allergic to.  Other kinds are inflammatory and infectious.  The latter two kinds are thought to be caused when the openings of the oil glands, called the meibomian glands, along the top edge of the bottom lid and the bottom edge of the top lid, become blocked by sebaceous or oily material or bacteria.  The stagnant oil in the glands often gets infected.

Moderator:  Who gets blepharitis?  Is it more prevalent in a glaucoma patient using eyedrops?

Dr. Rick Wilson:  Blepharitis is most commonly seen in adults.  It seems that abnormalities in oil gland function, and/or a change in the bacterial colonies that normally live on the skin, contribute to the development of blepharitis.  In my experience, glaucoma patients do not seem to be more prone to the inflammatory or infectious type of blepharitis.  They are much more likely, however, to be subject to allergic blepharitis from the glaucoma drops they use.

P:  My doctor has recommended hot compresses and keeping my eyelids and lashes immaculately clean.  I have tried erythromycin ointment and cilia ointment.  The ophthalmologist usually turns back my eyelids and cleans the undersides.  My eyes are somewhat improved, but they are still itchy, irritated, and sore.  I feel I am doomed to have this irritating disease forever.  Do you know of any research that might give hope to those of us suffering from blepharitis?

Dr. Rick Wilson:  For chronic cases, oral antibiotics may be needed to get to the bacteria in the bottom of the oil glands along your lids.  I don't know much about the research going on, since it is not in my field.

Moderator:  What are the symptoms of blepharitis? 

Dr. Rick Wilson:  Usually, the main symptom is red, inflamed eyelids, especially along the margins of the lids.  Crusting and sticking together of the eyelids in the morning are common with the infectious type.  All types are often accompanied by irritation of the eyes.  Dry eyes and rosacea, a skin condition, may also accompany blepharitis.

Moderator:  What kind of doctor usually treats blepharitis?

Dr. Rick Wilson:  Most general ophthalmologists treat blepharitis, although severe conditions may require a cornea and infectious disease subspecialist. 

P:  My daughter has tried everything.  The latest treatment is a pinch of soda in water to soak the eyelids.  She was wondering if she has a yeast infection.

Dr. Rick Wilson:  I haven't heard of yeast infection in the eyelid glands, but that doesn't mean it doesn't happen.  I think it would be very unusual.

P:  My glaucoma specialist referred me to an ophthalmologist to treat my blepharitis.  Without exception, every glaucoma specialist I have ever seen has downplayed the blepharitis and concentrated on my severe glaucoma.  Is it correct to assume that most glaucoma specialists do not take blepharitis very seriously?

Dr. Rick Wilson:  They, like most subspecialists, concentrate on what they know best.  I think they take blepharitis seriously, but do not concentrate on it unless you make a point of it.

P:  Wouldn't topical antibiotics work just as well as oral antibiotics?

Dr. Rick Wilson:  No, because they would not be able to travel down the long neck of the oil gland to the bulb where the oil is made.  When that oil becomes infected, prolonged treatment with oral antibiotics is needed to eradicate the infection.  Most people live with the infection by keeping their lid margins quite clean and allowing the infected oil to drain all the time to prevent a backup of oil and a resultant sty.  

P:  Which oral antibiotics are recommended?  Doxycycline didn't seem to help me. 

Dr. Rick Wilson:  Usually, doxycycline, tetracycline and erythromycin are the antibiotics used.

P:  Can severe blepharitis cause more damage for glaucoma patients?  Can it increase IOP (intraocular pressure), or harm the optic nerve, corneas, or retina?

Dr. Rick Wilson:  Severe blepharitis cannot do more damage to the optic nerve.  It will not raise IOP, unless steroids are given as part of the treatment.  The cornea is often affected as a bystander; the retina, never.

P:  Could blepharitis have added to the deterioration of my stem cells?  

Dr. Rick Wilson:  I'm afraid I don't have the experience to answer that.

P:  Are the glaucoma eyedrops the cause of blepharitis, or is it the preservative in the eyedrops?  

Dr. Rick Wilson:  Both can cause a mild, chronic allergy, or a rip-roaring allergic blepharitis.

P:  Can a person have dry-eye syndrome and not have blepharitis?

Dr. Rick Wilson:  Yes, commonly.  Although dry eyes decrease your eyes' natural resistance to infections.

P:  Are those with aniridia more prone to blepharitis? 

Dr. Rick Wilson:  No.  But aniridics often have mega problems with their corneas.

P:  Does eyelid swelling usually accompany blepharitis, and can it cause subtle blurriness?

Dr. Rick Wilson:  Yes, as can the build-up of bacterial waste products in the tear film, and irritative changes to the cornea.

P:  Would routinely washing the eyelids after using the eyedrops help to prevent irritation?

Dr. Rick Wilson:  If you had allergic signs or symptoms of the eyelid, then keeping the drop off the eyelid could help.  Be careful when washing the eyelids not to get water in the eye, which could dilute the medical properties of the eye drop.

Moderator:  What is the difference between seborrheic blepharitis and staphylococcus blepharitis?  Which one is the bacterial type?  Are both types treated the same?  

Dr. Rick Wilson:  Seborrheic blepharitis is usually caused by dysfunction of the oil gland in the lid margin.  There is an overproduction of oil, and the oil  gets inflamed if the glands become blocked.  Staph (staphylococcus) blepharitis is often a chronic infection of the oil glands along the lid margin that can be difficult to cure.   Styes and chalazia, along with crusting and scaling around the eyes, is common.  Mild forms are treated with hot compresses to open the oil glands and help them to drain.  Lid scrubs with a terrycloth washcloth and diluted baby shampoo help to remove crusts and anything that might block the openings to the oil glands.  If an infection is present, a topical antibiotic is used.  Severe infections require treatment for two to four weeks or more with oral antibiotics like tetracycline or doxycycline.

P:  Can punctal occlusion plugs increase the chance of getting either kind of blepharitis?

Dr. Rick Wilson:  Not in my experience. 

P:  Can wearing contact lenses for decades cause blepharitis?

Dr. Rick Wilson:  I think contact lens wear can add to the overall irritation of the lids and cornea.  In susceptible people, that can result in changes in the lid margin.  

P:  I'm a bit squeamish about cleaning the eyelid of the eye with a bleb.  Any suggestions for protecting the bleb?  And what does an eyelid scrub consist of?

Dr. Rick Wilson:  I would pull the lid away from the globe and look in a direction to try to put the bleb out of the way, either way, up under your lid (probably best) or way inferiorly.  A scrub can just be warm water on a cotton-tipped applicator or a clean washcloth. You can add diluted baby shampoo, or you can buy commercial scrubs.  

P:  My husband, who is a tree pruner, has had blepharitis for decades.  Over-the-counter eyedrops have worked well for him.  But will they continue to work?  They stopped working for my daughter. 

Dr. Rick Wilson:  Are the eyedrops he is using a lubricant or an anti-allergy drop?

P:  Anti-allergy, I think. 

Dr. Rick Wilson:  He probably has a mild allergy that he is exposed to in his work and the drops do the job.  Your daughter may have a different type of blepharitis.

P:  Can punctal occlusion plugs decrease blepharitis by helping with dry eye?

Dr. Rick Wilson:  The plugs will help with the dry eye.  The blepharitis is usually more difficult and will require specific treatment.

Moderator:  What is the difference between anti-allergy eyedrops and lubricating eyedrops?

Dr. Rick Wilson:  An anti-allergy drug may have an antihistamine or mast cell stabilizer in a lubricant-drop base.  A lubricant does not have any medication in it.

P:  Contact lenses were the best way for me to have good vision (acute myopia).  Blepharitis was just a minor problem.  

Dr. Rick Wilson:  I'm glad, but wearing contact lenses increases the risk of blepharitis, so I would be very careful about the contact lens care and hygiene.

P:  What's the difference between a sty and blepharitis?

Dr. Rick Wilson:  A sty is like a tiny boil. One oil gland becomes infected and filled with pus.  

P:  Would you recommend the one-day contact lenses to reduce the risk of blepharitis?  

Dr. Rick Wilson:  Yes, I think they are the safest.

Moderator:  Thanks for your time, Dr. Rick. 

Dr. Rick Wilson:  Good night, everyone. Have a great Thanksgiving.

End of highlights for November 20, 2002.

On Novebmer 27, Dr. Werner discussed "Inflammation" in the Chat room. Click here for highlights of that meeting.

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