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What Are Inflamed Eyelids (Blepharitis)?

Blepharitis is a chronic inflammatory condition of the eyelids, secondary to an overgrowth of bacteria on the eyelashes and eyelids resulting in MGD.

The meibomian glands are situated in the upper and lower eyelids in close proximity to the eyelashes. They secrete lipid which is an important constituent of the tear film to protect the ocular surface from bacteria. Meibomian gland disease (MGD) is an umbrella term to describe a group of conditions affecting the Meibomian glands. It can be associated with other medical conditions such as rosacea, acne, seborrheic dermatitis and poor eyelid hygiene.

What is Blepharitis?

Blepharitis is a chronic inflammatory condition of the eyelids, secondary to an overgrowth of bacteria on the eyelashes and eyelids resulting in MGD. If untreated, a bacterial overgrowth producing a biofilm layer along the eyelashes can penetrate the ocular surface. Over time, the lacrimal gland will produce fewer tears with reduced anti-bacterial quality and the corneal surface becomes exposed. There is also an increase in telangiectatic blood vessels on the eyelid margin. This forms a vicious cycle leading to further accumulation of antibacterial toxins and ultimately can also cause eyelash loss and ocular surface damage due to chronic inflammation.

What are the symptoms of blepharitis?

Symptoms include red eye, burning, sticky eyes, excessive watering, ocular discomfort, light sensitivity and foreign body sensation. It can also cause excessive eyelid closure or twitching, ‘blepharospasm’, which sometimes requires regular botulinum toxin injections around the eye and brow region.

How is it diagnosed?

The diagnosis is made by performing a full anterior segment eye examination on the slit lamp by an ophthalmologist. This includes fluorescein assessment of the ocular surface, eversion of the upper eyelids and measurement of the intraocular pressure alongside a full medical history.

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What treatments are available?

There is no cure for blepharitis, and so the mainstay of treatment at all stages is lid hygiene to control the bacterial build-up. Other treatments such as antibiotics, steroids and ocular lubrication may also be necessary for different sequelae of the condition.

BlephexTM is a medical device used to control blepharitis. It has been shown to be a viable alternative to the traditional time-consuming methods of lid hygiene such as eyelid scrubs. BlephexTM is a form of microexfoliation along the edge of the eyelids and lashes to remove biofilm collections. The procedure is well tolerated with eye drop anaesthesia, taking under 10 minutes, and is repeated every 4-6 months depending on the clinical response. Studies have shown that at 4 weeks there is an improvement in dry eye symptom scoring systems, tear film stability and meibomian gland function. It is also a useful tool for cleaning the eyelids and eyelashes to prevent biofilm build-up in the absence of blepharitis or in the early stages of the disease.

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