Fergus Falls Optometric Center
"Family Eyecare from the Eyecare Family."
Dr. Mark D. Olmsted and Dr. Christine A. Olmsted
117 E. Lincoln Ave.
Fergus Falls, MN 56537
Appointments: 218-736-7555

Eyelid Disorders: Blepharitis

Eyelid Disorders: Blepharitis

By Dr. Mark D. Olmsted

Frequently, I see patients that have crust build-up on their eyelids. This is usually paired with redness to the rim of the eyelid and often with some swelling. This lid condition is called blepharitis. While it may seem like a small issue, it can be quite chronic and problematic to the point or causing tear layer problems and very severe infections in some cases.

Blepharitis comes in different forms. The condition is very much like dandruff of the eyelids. For the purpose of this article, I’m going to keep things fairly general.

First of all, an explanation of the basic anatomy of the eyelid will help the reader understand more about blepharitis. The outermost aspect of the lid margin is where one’s lashes grow. There are a series of sebaceous (oil) glands (Zeiss glands) at the base of the lashes, the ‘external’ oil glands. The innermost part of the lid closest too and in contact with the eye has a different and larger series of oil glands called Meibomian glands that run internally in the eyelid. The Meibomian gland secretions are an important part of our tear layer.

Staphylococcal bacteria are a normal ‘hitch-hiker’ on our skin. However, in poor hygiene scenarios too many of these bugs will cause infections. Staph gravitates to the external oil glands of the eyelid. The environment is moist and warm…quite suitable for bacterial growth. Some people with have a skin-type that puts out a thicker poor quality sebum (oil) that tends to be almost like beeswax in consistency in the extreme cases. This waxy buildup combined with dead skin cells and staph germs creates the recipe for generalized blepharitis, and one gets a low grade infection along the lash-line. This creates the red, crusty deposits on the base of the lashes. The waste products of the bacteria spill into the tear layer causing an almost soap-suds like froth that wreaks havoc on the comfort of the eye. The tear layer doesn’t work properly in this situation, not to mention the fact that the infection of lid can spread to the eye itself if it is advanced enough.

Examples of more advanced blepharitis infections include styes (hordeolum) that can affect both the Zeiss gland (external hordeolum) and the Meibomian gland (internal hordeolum. Eyelashes can fall out and become thinner (maderosis). Ulcers of the eyelid can even occur. And as mentioned before, if the infection is aggressive enough it can spread to the eye itself causing a specific type of bacterial conjunctivitis known as blepharoconjunctivis.

When an infection is involved the treatment is a combined approach of both more focused and regular eyelid hygiene (preceded by a warm washcloth soak to soften the crusts) and antibiotic drops and ointments when necessary. Some people just have a skin type that is more prone to blepharitis. They have almost a constant cycle of repeated bouts of the condition. Those folks could take five showers a day, but unless they address the lash line more directly, the staph colony can get out of control.

My favorite over-the-counter lid scrub preparations are SteriLid and Ocusoft Plus. I prefer to recommend the foam that is dispensed from a small can similar to shaving cream and used with a clean washcloth. These are newer products that are designed not only to be non-irritating to the eye, but they will actually kill much of the bacteria, while washing off the deposits on the eyelashes. If someone has an active infection, I have them use a warm-soak/lid scrub regimen of twice a day for a week and then antibiotics when needed. As a maintenance therapy I recommend continued lids scrubs 2 to 3 times a week as a preventative measure to keep the normal staph population in control. Oral omega-3 fatty acid supplements in the form of fish oil capsules can help to keep the skin oils to more freely flow, which helps the tear-layer and decrease lash line build-up at its source.

If these conditions seem familiar to your life, please never hesitate to set up an appointment with an eyecare provider like myself to get you back on track for healthy eye comfort.