How do eyelids work?


The eyelids protect the eye and they also spread the tears over the surface of the eye to maintain clear vision. Within the eyelids there are many small sebaceous glands called meibomian glands. These produce an oily substance in the tears to slow the rate of tear evaporation.


What is blepharitis?


Blepharitis (pronounced blef-a-right-is) is a common inflammation of the eyelids. It occurs more frequently in older people.


There are two main types of blepharitis:


Anterior blepharitis This affects the base of the eye lashes with a dandruff-like condition. It is due to a low grade staphylococcal (bacterial) infection in the eyelids


Posterior blepharitis This is due to an overaction of the meibomian (sebaceous) glands that can become blocked, inflamed and infected.


What are the symptoms of blepharitis?


Typical symptoms are irritation, soreness and redness of the eyelids. There may be grittiness and sometimes watering of the eyes. There may also be crusting around the eye lashes and some patients will have a discharge from their eyes.


What is the treatment for blepharitis?


The mainstay of treatment is regular lid hygiene to reduce the inflammation in the eyelids. This needs to be carried out regularly, between daily and weekly, over the long term to prevent the symptoms returning.


How do I perform lid hygiene?


Steam bathing. This is needed to soften the oily secretions in the eyelids. Boil some water and pour into a small bowl. Close your eyes and hold over the steam for about 10-15 minutes so that the lids are gently warmed but not so that they become uncomfortable.




Warm compresses. Soak a clean flannel in hot water and hold against closed eyelids for a few minutes.





Cleaning the lids: This is performed to remove any debris that has accumulated on the lid margins. Use a cotton bud dipped in a solution to clean along the base of the lashes in the upper and lower lids using a side-to-side wiping motion. Avoid rubbing the inner surface of the lids.


Make up a solution to moisten the cotton bud by filling an eggcup with cooled, boiled water and adding one of the following to it:


- a drop of baby shampoo

- half a teaspoon of bicarbonate of soda.


Alternatively use an over the counter preparation such as Ocusoft (Scope Ophthalmics), LidCare (CIBAVision), Blephaclean (Spectrum Thea), Blephasol or Supranettes (Alcon).


Are there any other treatments for blepharitis?


Ointments for the lids: Chloramphenicol ointment is used at night, for a few months to treat low-grade infections with the staphylococcus bacteria. If the lids are very inflamed then a short course of Betnesol (steroid) ointment is given to settle the inflammation. Both these ointments are applied with a cotton bud, and rubbed into the base of the eyelashes.


Drops for the eye: To help soothe ocular irritation during the day, artificial tear drops are prescribed to be used whenever the eyes feel dry.


What happens if I don’t treat my eyelids?


The eye will continue to be sore and mildly inflamed. Sometimes the glands become blocked and swell up causing a meibomian cyst to develop. In severe cases these need a drainage operation.