Dry Eyes and Blepharitis
Blepharitis is a very common disorder amongst all age groups in Australia. It is an inflammation of the oil glands in the eyelids which causes irritation of the surface of the eye and symptoms such as grittiness, stickiness, dryness, redness, blurry vision, watery eyes and excess buildup of sleep in the mornings.
The oil glands (meibomian glands) normally produce very fine oil which goes into the tear film and lubricates eyelid blinking and prevents the watery part of the tears from evaporating. In patients with blepharitis the oil becomes thick and sticky. This abnormal oil causes the gritty sensation and allows faster than normal tear evaporation with dry eye symptoms, even if you are making lots of tears. The instability of your tears can cause intermittent blurring of vision.
Blepharitis cannot usually be cured, but appropriate treatment will make your eyes feel much better. The simplest measures involve cleaning the oil away from the margin of the eyelids. Follow these steps once or twice per day:
Take a face washer and run it under the hot tap. It needs to be quite warm but not so hot that you burn yourself. Close your eyes and place the face washer over your eyelids for 5 minutes. The heat melts the abnormal oil and improves blood flow to your eyelids.
To clean the excess oil from the openings of the glands you should clean with a cotton bud or gauze square moistened with either warm salt water or baby shampoo mixed with warm water. You need to close your eyes and gently wipe where the eyelashes join the eyelids, a bit like removing makeup. Even better are products such as SteriLid and Lidcare, which you can buy from a pharmacy. They are specifically designed for cleaning eyelids. Rinse off with warm water.
You should now instill some artificial tear drops. These will wash away any excess oil from your tears, and help lubricate the surface of your eyes. There are many effective artificial tear drops available over the counter from pharmacies and optometrists. The best ones are preservative free or have disappearing preservatives to reduce toxicity. Recommended drops include Systane Balance, Hylo Forte, Cellufresh, Bion Tears and Thera Tears. Artificial tears should be used between 2 and 4 times per day, or more often if you have worse dry eye symptoms. Some people will find a gel may provide more comfort, though transient blurry vision and sometimes stickiness may be noticed. Gels such as Celluvisc, Genteal Gel and Viscotears or an ointment like VitApos are particularly useful at night before going to bed.
The instability of the tear film caused by blepharitis may be helped with a tear supplement called Tears Again. This is a spray which goes on your closed eyelids. The spray contains an oil which gets into your tears to stabilize them. It may be particularly helpful for people with intermittent blurry vision and for those who struggle to use drops due to arthritis or other problems. Another medication called Novatears achieves the same effect but in a drop form which has minimal impact on quality of vision.
There is some evidence that patients with blepharitis may have improvement in their symptoms with omega-3 supplements. The main source of these essential fatty acids are fish, krill and flax seed oil, which can be found in tablet form at a pharmacy or health food shop. The omega-3 oil is thought to have an anti-inflammatory effect and to help the meibomian gland secretions to stay more liquid. I suggest taking at least 2 tablets per day to see if you notice any improvement, and continue if you do. If you do not notice any improvement after one month with these tablets there is no need to continue. There have been reports of increased incidence of prostate cancer in men taking high dose flax seed oil so fish oil is a better choice for men.
More severe cases of blepharitis may be helped with prescription medication such as antibiotic and steroid eye drops or long term oral antibiotics such as tetracyclines or doxycycline. There are some minor risks to using these medications which should be discussed before commencing treatment.
Another treatment which may help some people is IPL or Intense Pulsed Light. This treatment uses very bright pulses of light to the eyelids. It is generally administered as a painless treatment in the office over several months. This reduces inflammation and may reduce the presence of abnormal blood vessels in the eyelids. Results are variable, and certainly not everyone will get a benefit, but it is a harmless treatment which may be helpful in some cases.
Your blepharitis symptoms will commonly have better and worse days, depending on factors such as temperature, air conditioning and prolonged concentration such as computer use. Most people will find some of the above techniques to be more helpful than others. You should try them and use what works for you. It is a good idea to still clean your eyelids intermittently, even if your eyes are feeling better, in order to prevent recurrence of your symptoms.
Stay well hydrated
Use regular artificial tear drops or gels
Try omega-3 supplements
Regular lid hygeine
Intense Pulsed Light (IPL)