Glaucoma and Blepharitis
Chat Highlights
January 16, 2008

On Wednesday, January 16, 2008, Dr. Michael Pro, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma and Blepharitis".

Moderator:  Tonight's topic is “Glaucoma and Blepharitis.”  Would you like to begin with questions?

Dr. Pro:  Let's go.

P:  Is blepharitis an infection, an allergy, a inflammation, or something else?

Dr. Pro:  Blepharitis is very common and not unique to glaucoma patients.  It affects people of all ages, with or without glaucoma, but it is not an infection.  Rather, it is inflammation of the eyelids.  Specifically it refers to a build-up of oil and debris on the lashes and lids.  Most commonly, this is due to dysfunction of the oil-producing glands in the lids, the Meibomian glands.

P:  How is it diagnosed?  Are there specific blepharitis tests?  Does it involve blood work or eye exams?

Dr. Pro:  The diagnosis is clinical.  There is no blood test or any specific exam tests.  Rather the diagnosis rests on the appearance of the lids in the office as well as patient complaints.  Patients often feel that the eyes are irritated, itchy and burning.  The examiner may see red, inflamed lid margins and oily build-up.  Also there is associated breakdown of the usual tear film and the cornea may be dry.

P:  You say there is a breakdown in the tear film.  Does blepharitis affect tear production?

Dr. Pro:  Not directly, but the normal tear film is composed of three units.  There is an aqueous part, an oil part and a mucus part. If any part is out of order then the tear film does not coat the cornea properly and the eye feels irritated.

P:  Can blepharitis be cured?  What is best treatment?

Dr. Pro:  The treatment should be staged.  First, try to remove the offending agent.  So avoid heavy mascara and evaluate the drops that the patient may be using.  Patient hygiene is usually enough to improve mild blepharitis.  That includes washing the lids in the morning and the night with a soft washcloth and a diluted baby shampoo solution.  Artificial tears during the day can help prevent oil build-up, but in more moderate or severe cases this is not enough.  I sometimes use a very short course of an anti-biotic ointment on the lids.  This helps to alter the bacterial composition on the lids and improves symptoms in some patients.  Similarly a course of oral doxycycline seems to have anti-inflammatory properties.  Finally, supplementing the diet with flax seeds seems to improve the tear composition in some people and makes them feel better.

P:  Can we say then that flax seeds and intake of omega 3 could be considered as prevention?

Dr. Pro:  Yes.

P:  Is blepharitis caused from not washing ones face enough, or poor hygiene?

Dr. Pro:  Not really, some people seem more prone to it than others and they are otherwise clean. It is also seen in dishevelled individuals, such as homeless people who do not have access to showers.

P:  Is this usually a hereditary condition?  Is there an age range when it most commonly develops?

Dr. Pro:  It is not hereditary, and as with most problems in the eye it becomes more common with age.  And this is where glaucoma comes in—any drop placed in the eye can lead to irritation, and in the case with people who have blepharitis, long-term drop use can worsen their blepharitis and dry eyes.

P:  Is blepharitis of greater concern to patients who have had a trabeculectomy?

Dr. Pro:  Perfect lead in!  Yes, it is a problem in these patients because it can cause a bleb infection (blebitis) if the blepharitis is bad enough.  Above I had spoken about the bacteria in the lids; in blepharitis the bacteria are sometimes over-represented by species that may cause infection.

P:  Since using Lumigan, I have lid inflammation, a stye, or a chalazion on one eye or the other most of the time.  I take minocycline but I even get styes on the inside of my lower lid and the only thing that helped was TobraDex which I could only take for a short period of time because it’s a steroid ointment.  I also have very dry eyes.

Dr. Pro:  In your case, the drop may be worsening the blepharits and leading to recurrent chalazia (a blocked oil gland in the lid).  So your ophthalmologist may need to switch the Lumigan for a different agent to see if the blepharitis improves.

P:  Are styes and chalazia often seen in folks with blepharitis?

Dr. Pro:  More frequently than with others, yes.

P:  Do warm compresses help?

Dr. Pro:  They help in resolving chalazia or styes.

P:  Dr., are there any other implications for glaucoma patients specifically?

Dr. Pro:  Well, the other area of concern is in patients that need surgery.  If a patient has blepharitis I try to clear it up before surgery because there is a higher risk of post-operative infections in patients with moderate or severe blepharitis.

Moderator:  From an emailer ”My grandson (age three) has blephratis. They said that he would have it all his life and needs to use this special eye wash once a week as a precaution to it flaring, and more often when it flares up. He may also need antibiotics at times."

Dr. Pro:  For patients like that I do not hesitate to refer to a cornea specialist who treats only patients like that with severe cases.

P:  Does blepharitis ever resolve itself or is it always a lifelong battle?

Dr. Pro:  In my patients it seems to cycle.  I have aggressively treated some patients, removed drops and seen tremendous improvement.  It can always come back, but is usually fairly minor in most of my glaucoma patients.

Moderator:  Thank you Dr. Pro.  As always, your answers are very helpful and informative.  We'll see you in two weeks!

Dr. Pro:  I hope so.  I enjoyed the talk.

On February 6, Dr. Pro discussed "What is a Glaucoma Specialist?" in the Chat room. Click here for highlights of that meeting.

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