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Blepharitis and m.g.d ver nov 13
DR. ROSS LITTLEWOOD
(08) 9374 0620
MIDLAND EYE CLINIC
BLEPHARITIS AND MEIBOMIAN GLAND DYSFUNCTION
Blepharitis is inflammation of the eyelid margins. The typical signs are redness of the lid margins, an abnormally thin tear film that contains debris, and blocked Meibomian glands that can be detected with a microscope. The Meibomian glands normally produce an oily secretion that is essential in the maintenance of the tear volume. Symptoms may arise from an unstable tear film and lack of an oily lid border that feels like an irritant as it rubs across the eye during blinking. Recurrent episodes of inflammation usually occur during sleep, so mild irritation at bed time may be sufficient reason to apply an anti-inflammatory ointment before sleep. Blepharitis can be triggered by external irritants, a poor seal between the lids during sleep, or day time exposure air borne irritants. It is common in people with a skin condition called Rosacea.
What are the main symptoms?
Symptoms may include increased sensitivity to irritants (smoke, wind, cold temperatures), gritty or watery eyes, and difficulty focusing, especially on computers. Waking with ‘crusting’ on the lids, or red-rimmed watery eyes is common. Long-term complications may include in-growing eyelashes, lid “styes” and ulcers on the eye or lid margin.
What is the treatment?
The aim of management is to produce and maintain a “remission” of symptoms – since a permanent “cure” is no more likely than a cure for dry or oily skin. The cornerstone of management is to regularly empty the Meibomian glands before sleep and always go to bed with the tear film free of inflammatory material. This is accomplished by a 2 step clean up before bed.
Melt the dried secretions that block the drainage from the lid glands. Use a heat pack or hot water bottle on top of a flannel to maintain a temperature over 42 degrees Celsius on the outside of the lids for 4 minutes. Then massage the lids vertically - towards the lid margins. Any dried secretions on the lashes this material should also be wiped away using a cotton ball or cotton tip dipped in dilute bicarbonate solution (1/3 tsp to a cup of warm water). Do NOT use baby shampoo – it is a detergent and although it cleans the lids it dries the lid border and makes recurrences more likely.
Flush the eyes with a suitable artificial tear solution that is non-irritating (Artelac, Systane balance, Optive, or any preservative free drops are suitable).
During the day protect the eyes from strong drafts, dust, and chemical irritants, and use artificial tear drops containing oil (Artelac or Systane balance), or else oil free drops like Optive combined with an oily spray called “tearsagain.” The spray should be applied to the finger tip and wiped onto the upper lid margin immediately after the drops are used. If a sting occurs add an extra drop immediately and the sting will stop. Do not follow the instructions in the tearsagain pack or you will waste most of it.
Other treatments include "2 match-heads worth" of either Vitapos or 1% Siguent Hycor eye ointment rubbed back and forward from the fingertip onto the lid borders with the eye gently closed immediately before sleep. Vitapos is a preventative but for active inflammation Hycor is necessary. “Doxycycline” tablets and high dose oral fish oil supplements (8 capsules a day) are useful in resistant cases or for people with an underlying skin disease like Rosacea.
Filename Blepharitis and M.G.D Ver Nov 13
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