Blepharitis – Inflammation of the eyelids
Blepharitis is a chronic inflammation of the eyelid margins. It develops in painful episodes that cause eyelid swelling, a sensation of a foreign body, dryness, and excessive tearing. While rarely serious, it is nonetheless extremely bothersome and debilitating. It is often associated with facial rosacea. Treatment is chronic and long-term, relying on eyelid hygiene combined with moisturizing eye drops.
What is blepharitis?
Blepharitis is an inflammation of the Meibomian glands located within the eyelid. These glands are related to the sebaceous glands found on the face. They secrete meibum, a component essential for the stability of tears.
Blocked pores of the glands at the edge of the eyelids cause swelling with a burning sensation and dryness. Tears are of poor quality, impairing the tear film and sometimes vision.
Who is affected?
Blepharitis is an extremely common but rarely debilitating condition. In fact, it is the leading cause of dry eye.
Its incidence increases with age, pro-allergenic or polluted environments.
What are the symptoms of blepharitis?
The symptoms of blepharitis are numerous and fluctuating. They are primarily symptoms affecting the surface of the eye:
Redness of the eye and a sensation of a foreign body, predominantly in the morning upon waking or at the end of the day
Burning sensation at the edge of the eyelids
Sensation of a foreign body in the eye
Dry eye with paradoxical tearing (reflex tearing)
Recurrent chalazia
Visual fluctuations when blinking and photophobia
Blepharospasm and intense pain in cases of associated keratitis
Diagnosing blepharitis
The ophthalmological examination includes the examination of the eye as well as its adnexa. A detailed examination of the eyelids is performed using a slit lamp. With the eye closed, the ophthalmologist observes dilated blood vessels on the eyelid margins (telangiectasias) and concretions ("crusts") on the edges of the eyelashes.
Pressure on the edge of the eyelids, in addition to increasing the patient's sensitivity, reveals inflammation of the pores present on the edge of the eyelid and hyposecretion (decrease) of meibum.
Instilling a drop of Fluorescein® (a dye) allows for analysis of tear stability and corneal irritation. The tear film's breakup time, which protects the eye, is generally reduced. In severe cases, keratitis is frequently observed.
Blepharitis is an inflammation, which can be endogenous or exogenous (environmental). The main causes and risk factors of blepharitis are:
The environment – Dry or polluted air.
Allergens – Pollen atopy or eyelid eczema.
Makeup – Mainly eyeliner and mascara.
Facial rosacea – Chronic infection with toxin-secreting staphylococcus.
Treatment of blepharitis
Blepharitis is a chronic, recurring condition, meaning it progresses in phases of flare-ups and remissions, without a definitive cure. Treatment therefore relies on avoiding risk factors and maintaining a routine eyelid hygiene regimen. This includes:
Eyelid care: warm the eyelids for 2-3 minutes using a warm cotton pad, a heating mask or directly with warm shower water, then massage the edge of the eyelids in a makeup removal motion.
In cases of severe inflammation or lack of time, wipes (Blephaclean®) or micellar solution (Blephasol®) allow for quick treatment.
Rinse the eyes with saline solution if and only if there are secretions or crusts on the eyelashes.
Eye hydration with preservative-free artificial tears, providing tear stabilizers +/- a meibum analogue: Vismed®, Thealose®, Cationorm® or Hylolipid®
In cases of severe, crusty flare-ups, or associated rosacea, a course of antibiotics may be considered:
Eye drops – Bi-monthly courses of Azyter
Oral – Continuous oral doxycycline
Role of corticosteroids
In cases of severe inflammation, a short course of corticosteroids may be considered to relieve pain and soothe the eyelids.
However, their immediate effect does not treat the underlying pathology and masks the risk of long-term complications: dependence, inflammatory rebounds, glaucoma, cataracts.
Treatment with an immunomodulator (cyclosporine) should be considered in cases of excessive use of anti-inflammatory drugs.
Complications of blepharitis
Complications from blepharitis are rare but sometimes severe.
The cornea, in direct contact with the eyelids, suffers from contact inflammation and poor quality of the tear film.
The patient may therefore develop severe dryness, chronic keratitis or even a superinfection of the latter (corneal abscess).