February 1, 2012

Blepharitis: That Little Itch May Be Telling You Something

By William Benevento, M.D.
Eye Surgeons Associates

On my very first day as a resident in ophthalmology, I took care of a patient with blepharitis. One month later, I had lost count of how many people I had seen with the very same disease. Blepharitis is a very common and treatable disease of the eye.

The surface of the eye is the most sensitive part of the body; nowhere is there a denser packing of nerve endings. This is protective, causing reflex tearing whenever a foreign substance is on the eye, flushing it out. It also makes the eye much more susceptible to chronic irritation, such as that encountered with blepharitis.

Blepharitis is, by definition, an inflammation of the eyelids. People with it complain of itching, burning, tearing, crusting around the eyes (especially upon awakening), and a mild pain or a gritty feeling to the eyes. The hallmark of the disease is red eyelid margins with debris on the eyelashes. The debris can be caused by bacteria or seborrhea (like dandruff). As they accumulate on the lashes, some of the crusty flakes fall into the eyes (or are rubbed into them) and set up the irritation and tearing. They may also inflame the meibomian (oil producing) glands on the eyelid, further disrupting the tear film. To relieve the symptoms, the debris must be eliminated.

The good news about blepharitis is that frequently it is fairly easy to control; the bad news is that it’s nearly impossible to totally eradicate. The mainstay of therapy is warm compresses and eyelid scrubs. Initially, the compresses are used once or twice a day for a minute or two at a time to loosen up the debris on the lashes and open up the glands on the edge of the eyelid. The gentle eyelid scrubs are usually done with the same washcloth to remove the loosened debris and massage the lids. If the blepharitis is associated with a dry eye (as it commonly is), artificial tears are used to help with the symptoms. In severe cases, an antibiotic ointment, drop, or pill is added to the regimen.

Though most people with blepharitis do not suffer any significant long-term damage to their eyes, it is important to be examined and treated by an eye care specialist if you have the disease. Blepharitis can be associated with other disorders such as keratoconjunctivitis sicca (severe dry eye), acne rosacea, and seborrheic dermatitis, which may require additional (and more aggressive) treatment. Untreated, blepharitis can lead to recurrent styes, scarring of the eyelid margin, painful inflammatory reactions on the surface of the eye, and poor vision. Other ocular problems may look like blepharitis, including allergies, viral and bacterial infections, blockages of the tear ducts, and eyelid malpositions. Very rarely, even some forms of cancer may mimic a chronic blepharitis.

Most people with untreated blepharitis are miserable. Their eyes are red, itch, burn, and tear. If you or a friend have the symptoms of this controllable disease, please call your eye doctor. After all, that little itch may be telling you something.

President of Eye Surgeons Associates, Dr. Benevento is a board certified ophthalmologist. He has a special interest in diabetes and the surgical treatment of cataracts with the latest techniques. Dr. Benevento practices at our offices in Bettendorf and Muscatine Iowa. For more information, please visit our website: www.esaeyecare.com.