Inflammation of the eyelids, not only causes discomfort and irritation, but it also looks unattractive sometimes resulting in red-rimmed “Dracula” eyes. Untreated and, in the most severe cases, it can produce distortion of the eyelid, including eyelashes that turn inward (entropion) ultimately affecting vision. Known as blepharitis, this non-contagious condition is relatively common especially amongst Northern Europeans – Celtic skin types are believed to have a genetic predisposition to the problem. According to Google Trends, the UK has the second-highest incidence of blepharitis in the world – second only to New Zealand.
Oculoplastic surgeon, Jane Olver of Clinica London, explains that there are several different degrees of severity and two types of the condition: anterior and posterior.
Anterior blepharitis occurs at the outside front edge of the eyelid where the eyelashes are rooted; while the posterior version affects the eyelid’s inner edge. “Patients might be feeling a gritty or burning sensation in the eyes and come into the clinic with itchy red and swollen eyelids”, she said.
“This inflammation of the margin of the eyelids- particularly occurring on the lash line – will not affect a patient’s vision, despite being extremely unpleasant”, explains Jane. “Crusts of skin mixed with the oil from the eyelid glands can be seen (via magnification) at the base of the eyelashes. This can produce a small number of bacteria and subsequently, a low key infection may result – not enough to cause conjunctivitis for instance, but enough to make the eyelid margins dry and red.”
Posterior blepharitis may be caused by abnormal oil production from the eyelid’s Meibomian glands sometimes resulting in a chalazion or an eyelid cyst. It is also known to be linked to skin problems such as acne rosacea and – to a lesser degree – psoriasis. “It could be seen as an ocular form of the skin reddening condition acne rosacea – flare-ups can therefore sometimes be linked to various foods, high temperatures and alcohol”, explains Jane. Left untreated in the posterior margin – when the conjunctiva and Meibomian glands are affected – the eyelid can become misshapen and turn inwards with more serious consequences that may require surgical correction. “Many patients come to me with watering eyes –this can be caused by hypersecretion issues and also poor drainage. As such, they are often linked to blepharitis.”
Jane recommends a step by step approach to treating blepharitis depending on the degree of severity. Hot flannels placed over the eyes and a cleansing routine, with either weak bicarbonate of soda or baby shampoo solution, is recommended. An antibiotic cream can also help when flare-ups occur. “If I see a patient with symptoms and who also has reddening of the skin on the cheeks and nose, I would also suggest a closer look at their diet emphasising the importance of including foods high in the Omegas –which can also be increased with the help of dietary supplements. “
Jane adds that the most severe cases are treated with a long term course of anti-acne medication. Over an approximately nine-month period, such medications would alter the ph of the oil produced by the eyelid glands as well as the skin condition around the eyelashes.
“Blepharitis is a chronic condition that will need ongoing treatment management. Patients will have to look after their eyelids for life, as they do their teeth. We brush our teeth two or three times a day, well it’s the same with eyelid hygiene”, she concluded.
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