What is chronic eyelid inflammation and how is it manifested?

Blepharitis is a chronic eyelid inflammation caused by a blockage of the sebaceous glands located on the edge of the upper and lower eyelids. These glands are responsible for the production of the outer fatty layer of the tear duct, whose role is to cover the area between the eyelid in front of the eye area and delay the evaporation of tears (thus keeping the eye moist). When the sebaceous glands in the eyelids abnormally produce the oily layer of tears due to the inflammation, symptoms of dry eye appear. The inflammation causes swelling of the eyelids, discharge and sticky eyes, itching, irritation and redness of the eyes, a burning sensation, discomfort and blurred vision more significant in the morning. Blepharitis usually involves both eyes and is not contagious.

What are the causes of chronic eyelid inflammation?

The inflammation stems from an unknown cause, but there are several factors that are linked to it: a problem with the activity of the eyelid's sebaceous glands, allergies, parasites and bacteria that accumulate around the eyelashes and the nearby glands. The various causes include bacteria that naturally exist on the eyelids that may in some cases create an inflammatory reaction against them, various skin diseases such as seborrheic dermatitis or rosacea, parasites such as demodex (eyelash mite), dandruff in the scalp and facial area, and dysfunction of the sebaceous glands with advancing age.

How common is it and who usually suffers from it?

It is one of the most common disorders encountered in ophthalmology. It is estimated that eye care specialists detect blepharitis in about 50% of patients. Despite its prevalence, it is an often overlooked and misdiagnosed disease. The explanation for the disease being misdiagnosed or missed is due to a number of factors, but partly due to the fact that the patient's symptoms can be vague and varied. It affects adults and children of both sexes, but is more common in the elderly. In addition, those who suffer from scaling in the scalp and face area, rosacea (skin disease), oily skin and allergies are at an increased risk of developing blepharitis.

How can chronic blepharitis be treated?

It must be understood that this is a chronic condition and therefore the treatment is a long-term treatment. In addition, there is no curative treatment for the inflammation, but the symptoms can be soothed and the condition improved. There are several arms of treatment:

1. Avoiding eye makeup in order to reduce irritation, at least until the blepharitis is on the mend.
2. Applying warm compresses – you can use a gauze pad or a clean towel and wet it with warm water and gently place it on the eyelids for 10 minutes of heating, at least twice a day. The goal is that the fat in the glands will soften and it will be easier to remove them.
3. Cleaning the eyelids – use of special wipes for cleaning the eyelids. The cleaning will be done in the morning and in the evening and will allow the removal of secretions, scales and pollutants.
4. Applying an ointment containing prescription antibiotics and steroids on top of the eyelid. You should use the ointment before going to bed because it temporarily blurs your vision and can cause discomfort. Steroids reduce the inflammatory response that the body creates, but it is important to remember that steroids may cause side effects such as an increase in intraocular pressure and cataracts, so it is important to use them in the correct dose, in a suitable indication and only under the instructions of the attending physician. You can also give an oral antibiotic called doxylin which has an anti-inflammatory effect.
5. Preservative-free tear substitute drops can help deal with the feeling of dryness in the eyes and thus improve the blurred vision that patients report and the discomfort. The drops are bought without a prescription and are used as needed.

Persistence in treatment is necessary to prevent the inflammation from returning.

If persistence in the treatment for several weeks does not help, there are more advanced treatments available today:

6. Deep cleaning of the eyelid rim by microexfoliation: a device called Belfax. The treatment is done in a clinic setting. The device contains a small disposable swab at its end, which, through circular movements, removes keratin and bacterial plaque formed at the opening of the sebaceous glands, dandruff and other pests. The treatment is painless. and takes several minutes for each eye

IPL – Intense Pulsed Light 7. In this treatment, the area around the mammary glands on the border of the lower eyelid is irradiated with strong flashes of light. The treatment improves the quality of the fat secreted from the glands, reduces the chronic inflammation present in patients with blepharitis, and reduces the symptoms of the disease for a period of about six months.

8. Squeezing the sebaceous glands mechanically with special tweezers. Manual squeezing of the sebaceous glands on the edge of the upper and lower eyelids in the clinic.

The author of the article: Dr. Yael Sharon, a senior physician at the Rabin Medical Center, specializing in uveitis and surface inflammatory diseases, a lecturer in the Department of Ophthalmology at Tel Aviv University, works at the Dry Eye Center in Herzliya Pituach.