Let’s talk Blepharitis – with Dr Caroline Catt and Dr Michael Jones from Sydney Ophthalmic Specialists and both senior clinical lecturers with the University of Sydney.
Blepharitis is a very common eye condition that affects adults as well as children and even babies. Blepharitis is inflammation of the eyelids, causing them to become red, swollen, burning or sore and have flakes or crusts at the base of the eyelashes.
As an inflammatory condition, it can sometimes have an infective component, so it can be related to infection with certain bacteria, such as staphylococcus, streptococcus, or even some viral infection or more common inflammatory conditions like rosacea. In babies and toddlers, it's usually an inflammatory condition not related to those infections and is very uncommon in babies under 12months of age. However, in kids it can also go undiagnosed for a long time.
In kids, it's a type of condition related to gland production, that can result in a blockage in the gland itself, which some people know as a sty. Kids often present with blinking and eye rolling or eye rubbing. We see that a lot more in kids with screen time because when they are watching the screen, they don’t blink as much as they should. So that dries the eye out and makes them susceptible. So homeschooling but also TV watching can increase this.
Who is at risk of it?
Blepharitis is very ubiquitous, there isn't anyone who's immune from it. It can appear in all families and skin types. There are certain hereditary conditions that can make kids between 3 to 10 more susceptible to blepharitis, such as rosacea, excema, and underlying allergies. But also adults that have rosacea (more specifically ocular rosacea) and other dry eye syndromes that can get Blepharitis more commonly.
How is Blepharitis diagnosed?
The most powerful way to diagnose blepharitis is actually to look at the eyelid margins and listening to the symptoms the patient is experiencing. To investigate the eye, Ophtalmologists use a piece of equipment called a slit lamp, which works like a big microscope that lets them look at the front of the eye and at the meibomian glands. These are tiny oil glands which line the margin of the eyelids (the edges which touch when the eyelids are closed). These glands secrete oil which coats the surface of our eyes and keeps the water component of our tears from evaporating (drying out). Sure signs of Blepharitis are if those glands are blocked by oil or the glandular secretions are stuck in the eye or form crusts along the roots of the eye lashes, or the sequelae of blepharitis such as conjunctivitis, or dry spots on the cornea is visible, then Blepharitis can be diagnosed.
What treatment options are there?
There's a number of different ways to treat Blepharitis and the underlying principle is to reduce inflammation within the eyelids.
If there is any change to your vision. If you think you're visually suffering, if your eyes feel painful, and if they're not responding well to those simple treatments discussed above. It is always good to have children seen by a Doctor, especially because historically they are often under diagnosed. And there are cases of children that had vision threatening complications from Blepharitis. One of the extreme complications of Blepharitis is scarring of the cornea, which can leave to permanent vision complications. Therefore it is recommended that when your child is presenting with reoccurring red eye to have it checked out.
Diet is a very important factor. There is evidence that supplementation with omega 3 and 6 as well as flaxseed oil can have a preventative effect.
See an extract below or watch the full interview here
What is Blepharitis and what causes it?
Blepharitis is a very common eye condition that affects adults as well as children and even babies. Blepharitis is inflammation of the eyelids, causing them to become red, swollen, burning or sore and have flakes or crusts at the base of the eyelashes.
As an inflammatory condition, it can sometimes have an infective component, so it can be related to infection with certain bacteria, such as staphylococcus, streptococcus, or even some viral infection or more common inflammatory conditions like rosacea. In babies and toddlers, it's usually an inflammatory condition not related to those infections and is very uncommon in babies under 12months of age. However, in kids it can also go undiagnosed for a long time.
What are the most common signs and symptoms of Blepharitis?
In kids, it's a type of condition related to gland production, that can result in a blockage in the gland itself, which some people know as a sty. Kids often present with blinking and eye rolling or eye rubbing. We see that a lot more in kids with screen time because when they are watching the screen, they don’t blink as much as they should. So that dries the eye out and makes them susceptible. So homeschooling but also TV watching can increase this.
Another factor to consider in kids is allergies, an allergy can become an autoimmune problem and the cornea on the fron of the eye can become unhealthy or damaged as a result. Therefore as parents it is worth being aware of these symptoms and that it is well worth having their eyes checked out.
For adults its more typical that they get a feeling of dry eyes, a certain quirkiness or sandy feeling, along with some redness in the eye.
Who is at risk of it?
Blepharitis is very ubiquitous, there isn't anyone who's immune from it. It can appear in all families and skin types. There are certain hereditary conditions that can make kids between 3 to 10 more susceptible to blepharitis, such as rosacea, excema, and underlying allergies. But also adults that have rosacea (more specifically ocular rosacea) and other dry eye syndromes that can get Blepharitis more commonly.
Wearing contact lenses can aggravate the condition though. Because even the best designer contact lenses are a foreign body, that tend to cause a little bit of irritation on the surface. It is worth trying new lens types as some are more prone to rubbing than others and lens technology has progressed significantly, and they are a lot more water friendly these days. Another important factor is how much you wear your contacts.
How is Blepharitis diagnosed?
The most powerful way to diagnose blepharitis is actually to look at the eyelid margins and listening to the symptoms the patient is experiencing. To investigate the eye, Ophtalmologists use a piece of equipment called a slit lamp, which works like a big microscope that lets them look at the front of the eye and at the meibomian glands. These are tiny oil glands which line the margin of the eyelids (the edges which touch when the eyelids are closed). These glands secrete oil which coats the surface of our eyes and keeps the water component of our tears from evaporating (drying out). Sure signs of Blepharitis are if those glands are blocked by oil or the glandular secretions are stuck in the eye or form crusts along the roots of the eye lashes, or the sequelae of blepharitis such as conjunctivitis, or dry spots on the cornea is visible, then Blepharitis can be diagnosed.
What treatment options are there?
There's a number of different ways to treat Blepharitis and the underlying principle is to reduce inflammation within the eyelids.
- It is crucial to remove all eye makeup at the end of the day. This is important because any foreign material staying there for a long time can worsen any Blepharitis.
- Apply a warm compress over the eyes once or twice a day. To do this use a washer and warm it with bath temperature water, wring it out and hold it over each eye one at a time for at least thirty seconds. The heat will warm up the blocked oil and make it easier to remove it from the glands to the surface of the eye where it's supposed to be.
- Clean the roots of the lashes where crusts and inflammatory debris is accumulating. There are a number of different products you can use to clean right along the route of the eyelashes. Make sure you clean right where you would apply eyeliner along the lash roots.
- Blepharitis occurs in association with dry eye so lubricating eyedrops can help.
- Taking enough omega 3 oil, either through eating fish, or through a dietary supplement can be helpful as well.
- And then there are certainly conditions where there is a role for oral antibiotics, or topical antibiotics, or even topical steroids.
Good lid care is fundamental, and there are great results for both adults and kids. Instructing patients on lid hygiene and lid care and getting them on a good routine pays off. All proposed treatments (antibiotics orally or topically or steroids or even surgery) should always be followed by good lid care, and if that is done correctly patients normally do not neeed to have further treatment. In Dr Jones experience only patients that stopped doing good lid care relapsed.
As good lid care needs to be an ongoing routine it is best to keep it simple, to make it easy to stick with it. It should become part of your bathroom routine to wash your eyelids. Dr Jones recommends a tear-free baby shampoo. Use a little bit of foam on a face wash or your fingers and gently shampoo the eyelashes. This plugs the glands, cleans up the lid margin and helps to get rid of some of the debris.
A home remedy that's effective is using bicarb in water. Boil one litre of water and dissolve a teaspoon of bicarb. This is safe and gentle on the surface of the eye.
When should you see a doctor?
If there is any change to your vision. If you think you're visually suffering, if your eyes feel painful, and if they're not responding well to those simple treatments discussed above. It is always good to have children seen by a Doctor, especially because historically they are often under diagnosed. And there are cases of children that had vision threatening complications from Blepharitis. One of the extreme complications of Blepharitis is scarring of the cornea, which can leave to permanent vision complications. Therefore it is recommended that when your child is presenting with reoccurring red eye to have it checked out.
Are there any other preventative measures that can be implemented?
Diet is a very important factor. There is evidence that supplementation with omega 3 and 6 as well as flaxseed oil can have a preventative effect.
There are triggers that can cause a Blepharitis outbreak, specially if your Blepharitis is linked to Rosacea. In this case it is important to know your triggers and avoiding them. These could be drinking alcohol, a sudden change in temperature, coffee or spicy food. Then add good lid care and lubricating eyedrops and this will reduce the chance of those exacerbation.
Key points to take away about Blepharitis
It is a very common condition that we all should be aware of, many patients of the Sydney Ophthalmic Specialists present with underlying Blepharitis and raising awareness will help hugely. Even though it is not a life-threatening disease in itself, at its worst, it can be eyesight threatening. There are some very effective and safe measures as discussed above and managing it properly can be lifechanging.
I have been chatting to Dr. Caroline Catt and Dr. Michael Jones who are ophthalmologists or eye specialists from Sydney Ophthalmic Specialists based in Sydney. Dr. Caroline Catt graduated with an undergraduate and medical and a master's degree from the University of Sydney and Flinders University of South Australia. She has a keen interest in teaching ophthalmologists in training and is a clinical senior lecturer at the University of Sydney. Dr. Michael Jones is currently the Head of the Department of Ophthalmology at the Children's Hospital Westmead. He is head of the Strabismus Unit at the Sydney Eye hospital, and a senior clinical lecturer with the University of Sydney.
Thank you so much for your time, Dr. Catt and Dr. Jones.
