What is eyelid inflammation (blepharitis)?

In common parlance, the word blepharitis refers to inflammation of the eyelids. Doctors, on the other hand, limit the clinical picture of blepharitis and use it to describe every form of eyelid inflammation more specifically. The edges of the eyelids are the areas of the eyelid where the eyelashes attach.

Forms of blepharitis

Ophthalmologists classify blepharitis into two types : on the one hand, according to where it occurs on the eye, and on the other hand, according to the cause.

With regard to the location, they distinguish between anterior blepharitis and posterior blepharitis. Anterior comes from Latin and means "front" or "lying in front". Posterior is translated as "back" or "further back". In the following, the anterior blepharitis is always referred to as anterior blepharitis and the posterior blepharitis as posterior blepharitis.

Anterior blepharitis usually affects the base of the eyelashes. This means that the symptoms can be seen a little further out on the edge of the eyelid. It is triggered by bacteria or by increased sebum production. The bacterial form is called staphylococcal blepharitis in technical terms. Blepharitis, triggered by increased sebum production, is known as the seborrheic form.

Posterior blepharitis shows up a little closer to the eyeball. It affects the so-called meibomian gland, which is why doctors also refer to it as meibomian gland dysfunction. This form of blepharitis is predisposed and incurable.

Symptoms of blepharitis

Patients with blepharitis often have very specific symptoms. The eyes are red, water frequently, and get tired more quickly than usual. The conjunctiva is also irritated and a yellowish secretion collects on the edge of the eyelid, comparable to pus.

Some patients have whitish scales on the lash line. If the scales fall into the eye, it feels like there is a foreign body in the eye.

Other symptoms are swollen eyelid rims, which can also be sticky and reddened. Sometimes patients report that the eyes or the eyelid rims hurt and itch.

In addition, the eyes are more sensitive to light and vision fluctuates. In some cases, patients lose eyelashes, are more sensitive to glare and can no longer tolerate contact lenses.

However, you should note that not every patient has all symptoms at the same time. You can find out whether you have blepharitis and what type of blepharitis you have based on the respective symptoms and the time of day during which the described symptoms appear.

If you suffer from red eyes that secrete a lot of secretion, the most likely bacterial form of blepharitis is staphylococcal blepharitis. With this form, the symptoms usually appear in the morning . If the pain in the eyes and the eyelid rims are moderately red, it is probably the seborrheic form of blepharitis. Patients with meibomian gland dysfunction often only feel the symptoms during the day .

Unlike conjunctivitis , for example, blepharitis is not contagious . How the disease progresses cannot be compared either. Because blepharitis begins insidiously, often develops over weeks or months and the symptoms only appear over time.

Causes: how does blepharitis develop?

The most common cause of eyelid inflammation is a malfunction of the sebum gland . The meibomian glands produce an oily film. This is part of the normal tear film and wets the surface of the eyes. Under the outer layer of the tear film there is an aqueous layer and one that protects against pathogens. If the fat layers are intact, they protect the tear film from evaporation. If this is not the case, the lid rubs directly on the eyeball with each blink. The result: the surface of the eye is irritated and supplied with more blood, the conjunctiva turns red. In addition, fat residues are deposited and a white-yellowish mucus develops.

The mucus leads to the itching that is typical of meibomian gland dysfunction. In some patients, the glands also close, causing the secretion to build up and hailstones. In the technical language, this hailstone is referred to as a chalazion.

People with meibomian gland dysfunction usually have oily skin that is prone to clogged pores. This condition can get worse as you get older.

Other factors that aggravate a meibomian gland dysfunction: medication, hormones, smoking, dry air, diet, computer work, thyroid diseases, rheumatism or skin diseases such as neurodermatitis .

If the patient does not suffer from meibomian gland dysfunction, the meibomian glands can still become inflamed . For example, when bacteria or other germs settle there.

Anterior blepharitis is mostly caused by bacteria. Scaly skin inflammation can also be a possible trigger.

Various cosmetics can also aggravate blepharitis . Often the ingredients of the products irritate the eyes and worsen the healing process.

People who are frequently exposed to dust, for example in the course of their work, can get irritated eyes from it. However, this does not cause blepharitis. The same applies to frequent work on the computer or television.

 

Suspected blepharitis: the examination

As soon as you have one or more symptoms of blepharitis, you should see an ophthalmologist as soon as possible . However, you should knows that there is no specific test used to diagnose blepharitis.

Therefore, the doctor will conduct a series of tests. Because some forms of blepharitis involve changes in the skin, he will take a closer look at the face and look for redness, papules, or pustules.

Another step in the diagnosis is an assessment of the eyelids. The doctor pays particular attention to possible deposits such as flakes or secretions. In addition, the tear film is examined, the edge of the eyelid, the ducts of the meibomian glands, the conjunctiva and the cornea.

To rule out the possibility of meibomian gland dysfunction, the doctor takes meibomian secretions. Depending on how severe the pain is, it numbs the area. To remove the secretion, he exerts light pressure on the edge of the lid. If the meibomian glands are inflamed, the secretion is usually milky and voluminous. There are also pressure- and touch-sensitive lid edges. In seborrheic blepharitis, hardly any secretion will escape from the meibomian gland.

In addition, it can be useful to make an appointment with a dermatologist or family doctor. This will clarify whether internal causes trigger or worsen the blepharitis.

Treatment: This is how blepharitis is treated

The different forms of blepharitis can be treated in different ways. The forms of therapy include regular cleaning of the eyelid margin and heat therapy. Medicines can also be useful. If a skin disease is the trigger, it is usually treated as well. Surgical intervention may be necessary depending on the cause and severity of blepharitis.

Clean and massage the edges of the eyelids

Cleaning and massaging the edges of the eyelids is one of the most important measures and is used in all forms of blepharitis. One advantage: you can easily clean the eyelid rims yourself.

Massage the edge of the eyelid along the upper and lower edge of the eyelid two to three times a day. Cotton swabs or a moistened facial tissue are best for this. You can soak the cotton swab in baby shampoo, for example. You can also remove excess fat from the eyelashes and scales with mild cleaning solutions.

It is important that you clean the eyelid margins regularly and permanently. Otherwise, the pores will clog again. The first improvements are usually visible after three to four weeks.

The heat therapy

Many moderate forms of seborrheic blepharitis and meibomian gland dysfunction can be treated with high-altitude sunlight or a red light lamp. Alternatively, you can use moist, warm envelopes. These should be between 38 and 45 degrees warm. With both therapies, ten minutes are sufficient to liquefy the viscous secretion in the meibomian glands.

You can either use a heat gel mask or a washcloth for the moist, warm envelopes. If you use the gel mask, you should also put warm, damp cotton pads on your eyes. You can then massage the liquid secretion from the meibomian glands. It works as follows: Close your eyes and gently stroke your finger several times on the upper and lower eyelids in the direction of the cleft.

Medication

If bacteria have caused blepharitis, you must take antibiotics. The doctor will usually prescribe an ointment for you to use for a maximum of ten to 14 days.

It can also be useful to use tear substitutes to treat the tear film disorder. Tear substitutes are either available as eye drops, or you can use ointments.

Surgical interventions

In particularly severe forms of blepharitis, the secretion builds up in the meibomian glands and a hail or stye forms . If none of the therapies described help, a surgical procedure is necessary in which the doctor removes the hail or stye.

Regardless of the type of blepharitis you have, you must be patient with the treatment. The inflammation of the eyelid rims is protracted, you often only notice the first improvements after several days, sometimes even after a few weeks.

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