Blepharitis

What is Blepharitis?

Inflammation of the lid margin is the most common disease of the eye.  It is often associated with dry eyes and can produce similar symptoms with soreness and a gritty sensation and in severe cases the lid margins themselves look red and can be associated with some redness of the eye.

There are two types of inflammation that affects the lid, an inflammation at the base of the lashes that produces crusting of the lid and lashes (like dandruff of the lashes) and an inflammation of the glands that produce an oil that contributes to the tears (it floats on the watery layer in the tears to stop the water from evaporating too quickly).  Inflammation of the oil glands in the lid is sometimes termed meibomianitis or posterior blepharitis as the gland that produce the oil are called meibomian glands and the pores are situated all along the upper and lower lid just behind the base of the lashes.  Most patients with blepharitis will have a combination of both crusting of the lashes and inflammation of the oil glands.

What is the treatment for blepharitis?

The main treatment for blepharitis remains regular bathing of the lid margins or “lid hygiene”.  This should be performed at least once a day (preferably first thing in the morning).  It should be performed as follows: Place a clean flannel under the warm tap to heat it up, then roll it up and place the flannel against the closed eyelids for several minutes.  This in itself is a comforting experience but the warm flannel will be heating up the oily secretions and any pores blocked by thick oils may become unblocked as the heat thins the oil.

After using the flannel any crusts on the base of the lashes or oils can be removed by gently but firmly wiping the lid margins (where the lashes come out) with either a gauze swab or cotton bud or ball that has been dipped in cooled boiled water to which a few drops of baby shampoo (which can be safely used around the eyes) has been added.   The main effect however is the simple mechanical removal of the debris that has been “loosened” by the hot flannel.  You can therefore try simply wiping the lid margins with cotton wool or gauze soaked in water.  There are also however “lid hygiene / lid care” kits available from the chemist that already provide clean gauze swabs and a bottle of sterile weak soapy solution and if you do not find you have much time in the morning these are the simpler solution but there is a cost associated with this.   There are also eye pads that you heat up in the microwave that can be used in place of a hot flannel.

Do not forget however that blepharitis is often associated with dry eyes and artificial tears may also help.

More severe forms of blepharitis can benifit from a short course of antibiotic tablets such as Azithromycin at a dosage of 500mg for one day then 250mg for 3 days and a short course of combined antibiotic and steroid ointment called Maxitrol that is applied to the lid margins twice a day for 2 weeks.  Sometimes a short course of steroid drops can also help more severe forms of blepharitis.  This type of treatment for severe blepharitis needs supervision by an eye doctor.

Problems we can help with

I will explain with the aid of video clips the various eye problems I treat.  This includes cataract surgery, refractive lens exchange in patients over 50 and medical and surgical treatments of all retinal and macular problems.

Cataract

I provides advanced micro-incision cataract surgery and will advise on the appropriate intra-ocular lens for your particular needs.  This includes toric lenses to correct astigmatism and extended range of vision multifocal lenses to reduce spectacle dependance.

Refractive Lens Exchange (RLE)

Patients with strong glasses or contact lenses who's natural lens has lost its ability to focus (usually over 50 years) may benefit from RLE to reduce dependance on glasses or contact lenses.  Surgery is beneficial for some but not all patients.

Macular Degeneration

Patients with wet (neovascular) age-related macular degeneration can benefit from prompt injection treatments with various anti-VEGF agents.  The first injection can usually be performed on the day of consultation as as "see and treat service".

Retinal Vein Occlusion

Blockage to the veins of the retina can produce significant visual disturbance and may require injection treatments with anti-VEGF agents or steroids at Exeter Eye. More severe cases may require laser or surgery at the West of England Eye Unit under Mr Simcock's care..

Diabetic Eye Disease

Diabetes is becoming increasingly common and can cause significant visual loss.  If detected at an early stage vision can be maintained using injection treatments with anti-VEGF agents or steroids.  More serious cases may require laser or surgery at the West of England Eye Unit.

Macular Hole

Mr Simcock has pioneered macular hole surgery in the UK and performs a technique which includes lens removal to prevent patients returning for cataract surgery.  The technique also benefits from no  or limited (2 day) face down posturing to allow hole closure in most macular holes.

Epiretinal Membrane

Scar tissue on the surface of the macular (central retina) causes blurring and distortion of vision.  Surgical removal of scar tissue with vitrectomy can be performed if sufficiently troubled. Most patients notice a significant improvement in vision and reduced distortion with this surgery..

Floaters

Patients troubled by floaters in their vision not improving over a period of at least 6 months may benefit from vitrectomy surgery to remove the floaters.  Patient selection is important and depends on age (usually over 50) and the state of the jelly (vitreous) in the main eye cavity.