Blepharitis Clinic

Blepharitis: Treatment

What to expect in our blepharitis clinic

We offer a personalised management and treatment plan customised to your particular type and severity of dry eye by utilising cutting edge, state-of-the-art diagnostic equipment and software combined with our clinical expertise and experience.

The aim of our specialist blepharitis clinic is to evaluate your tear film with regards to quality and quantity, lid margin health and tear producing glands, to understand why you have blepharitis and how best to alleviate your symptoms using the latest and most appropriate treatments available.

The blepharitis examination normally includes the following procedures:

  • Blepharitis pre-examination questionnaire – this helps us understand and track the improvement in your symptoms
  • High definition, high resolution photographs of the anterior eye (front of the eye) using our video/photo slit lamp biomicroscopes
  • Meibography – we visualise and assess the meibomian glands (glands which produce complex oils to stabilise your tears) to ensure their optimum performance
  • Anterior OCT – produce 3-dimensional cross sectional images of the cornea to monitor changes in the cornea and tear film thickness
  • Corneal topography – maps the shape and irregularities in the cornea
  • Non-invasive Tear break up assessment – using the Oculus Keratograph to measure the speed at which your tears evaporate
  • Assessment of the lipid layer (oil layer) of your tear film using the Keratograph
  • Use of fluorescein and lissamine green diagnostic dyes – these are used to assess the health of the front of the eye using our video/photo slit lamp biomicroscopes.
    This causes no discomfort or change in vision.
  • BlephEx professional eye lid cleaning – if you also suffer from blepharitis or meibomian gland dysfunction we may wish to clean your eyelids using the Blephex system, using a surgical microsponge to clear bacteria and debris from the eyelid and eyeslashes

How many visits will I require?

This varies depending on the type and severity of your dry eye. In most cases we will review you 2-4 weeks after the initial examination to ensure the treatment is working well and make changes to the treatment plan if required. Again depending on the extent of your dry eye we may then re-exam your eyes on a 3-6 monthly basis.

Are the treatments available on the NHS?

In Scotland the NHS will pay for a full examination every 2 years (every 12 months in patients over 60 with eye disease, diabetic patients of any age every 12 months, patients with glaucoma or ocular hypertension every 12 months, patients over 40 with a positive family history of glaucoma every 12 months and children aged 16 and under every 12 months). The NHS will also fund supplementary examinations to evaluate symptoms such as those of blepharitis. The NHS funded eye examination does not cover all of the techniques used to fully exam the eye for dry eye such as corneal topography, meibography, anterior eye photography and Blephex lid cleaning.

How does it work if I am referred by another optician?

If you have had an up-to-date and recent eye examination you simply book in for a blepharitis evaluation appointment. If you have not had a recent eye examination we will first perform a comprehensive eye examination followed by the blepharitis evaluation.

How much does it cost?

Initial blepharitis examination = £250 (£180 for Eye Care for Life members). A £120 non-refundable deposit is required to secure an appointment.

Follow up examination = £60 (£45 for Eye Care for Life members)

BlephEx Treatment = £48 (£36 for Eye Care for Life members)*

*BlephEx Treatment cannot be conducted unless a Dry Eye or Blepharitis examination has been completed and diagnosis made.

Does it hurt?

No, none of the examinations or treatments causes pain or discomfort. We may instil drops into the eyes in some cases which can be mildly stingy for a few seconds. However, the majority of the examinations involve nothing touching the eye. The Blephex lid cleaning session slightly tickles the eyelid but is not unpleasant.

What is Blepharitis?

Blepharitis is a condition where the edges of the eyelids become inflamed (red and swollen). It is a common condition; accounting for an estimated 1 in 20 eye problems reported to GPs. Blepharitis can develop at any age, but is more common in people over 40.

Blepharitis: What is it?

What are the symptoms of Blepharitis?

The symptoms of blepharitis vary from individual to individual but can include any number of the following:

  • Red, itchy eyelids
  • Sore eyelids
  • Eyelids stuck together and difficult to open upon wakening
  • Crusty or greasy eyelashes
  • A gritty or burning sensation in your eyes
  • Photophobia – an increased sensitivity to light
  • The edge of your eyelids becoming red or swollen
  • Abnormal eyelash growth
  • Loss of eyelashes
  • Contact lens discomfort

Most people with blepharitis experience repeated episodes, separated by long periods with no symptoms. In most cases both eyes are affected, and the symptoms tend to be worse in the morning.

Symptoms of other conditions

Blepharitis is sometimes associated with other health conditions, which may result in other symptoms.

For example, as well as the above symptoms, you may also have:

  • oily skin and dandruff – if you also have seborrhoeic dermatitis (a condition that causes your skin to become oily or flaky)
  • a constantly red face and spots – if you also have rosacea (a skin condition that mainly affects the face)
  • dry, gritty, sore or red eyes – if you also have dry eye syndrome (a condition where your eyes do not make enough tears or your tears evaporate too quickly)

What causes Blepharitis?

There are two main types of blepharitis:

  • Anterior blepharitis – where the inflammation affects the skin around the base of your eyelashes
  • Posterior blepharitis – where the inflammation affects your Meibomian glands (found on the inside edge of your eyelids)

Some people experience both types of blepharitis, as the causes are often linked.
Blepharitis is not contagious.

Anterior blepharitis

Anterior blepharitis can be caused by either a bacterial infection or a skin condition called seborrhoeic dermatitis. Staphylococcus bacteria are most commonly associated with blepharitis. These bacteria live harmlessly on the skin of many people but, for unknown reasons, they can cause the eyelids of some people to become inflamed.

Seborrhoeic dermatitis is a skin condition that causes skin to become oily or flaky, and it can sometimes irritate the eyelids. Seborrhoeic dermatitis often causes both anterior and posterior blepharitis at the same time.

Anterior blepharitis has sometimes been linked to demodex, which are microscopic mites that live on eyelashes. These mites are usually harmless, but may cause blepharitis in some people – possibly due to the eyelids becoming damaged or because of a sensitivity reaction. Some types of demodex mite have also been linked to cases of posterior blepharitis.

Posterior blepharitis

Posterior blepharitis occurs due to a problem with the Meibomian glands, which are found on the inside edge of your eyelids. The Meibomian glands are responsible for producing an oily substance that makes up part of your tears. A problem in these glands can lead to excess production of this oily substance or a blockage in the glands, which can cause the eyelids to become irritated and inflamed.

Excessive production of the oily tear substance is often linked to seborrhoeic dermatitis while blockages in the Meibomian glands are often due to a skin condition called rosacea.

Rosacea is a common, long-term skin condition that mainly affects the face. The first symptoms are usually episodes of flushing (when the skin turns red), but eye problems such as blepharitis develop in around half the people with the condition, as it progresses.

How blepharitis is treated

Blepharitis cannot usually be cured, but the symptoms can be controlled with good eyelid hygiene. Blepharitis is a long-term (chronic) condition. Most people experience repeated episodes, separated by periods with no symptoms.

Eyelid hygiene

It's important to clean your eyelids every day if you have blepharitis, whether or not you currently have any symptoms or are using one of the medications mentioned below. Good eyelid hygiene can help to ease your symptoms and prevent it happening again.

Follow the steps below to keep your eyelids clean:

  • Apply heat to the eyelid using a Thera Pearl Eyebag, an MGDRx Eye Bag or Blephasteam goggle for 5 to minutes
  • Then massage your eyelids with cleans hands to squeeze out blockages from within the glands
  • Gently rub your closed eyelids vertically and horizontally with a cleaning pad such as Blephaclean or Ocusoft lid hygiene pads to help loosen any crusting and push out any oils that may built up
  • Cleaning solutions and gels such as Blephasol or Blephagel, or cleaning foams such as Ocusoft Plus Foam or Thera Tear Sterild can also be used.

Try to avoid wearing eye make-up, particularly eyeliner and mascara, as this can make your symptoms worse. If you do wear eye make-up, make sure it is a type that washes off with ease so you can clean your eyelids every day more easily using the method described above.

Lids: Microwavable Compresses

Cleaning solution

There are many recipes for cleaning solutions and the best proportions or products to use can vary, depending on the individual. It is commonly advised to use a baby shampoo solution, but it is our opinion that this should never be used as it will worsen any symptoms of dry eye. Over the counter cleaning solutions are much better, more effective and safer.

BlephEx - In office eyelid cleaning procedure

In some cases of Blepharitis we may advise a deep clean of the eyelids using the BlephEx system. BlephEx is a painless in office procedure performed by our optometrists. The revultionary BlephEx handpiece is used to very precisely and carefully, spin a medical grade along the edge of your eyelids and lashes, removing bacterial and debris and exfloiting your eyelids.

The procedure is painless and most patients simply report a mild tickling sensation, a numbing drop is placed in each eye prior to treatment for increased comfort.
The procedure only takes around 5 minutes.

Topical antibiotics

If you have blepharitis that does not respond to regular cleaning, you may be prescribed a course of antibiotic ointments, creams or eye drops (topical antibiotics). You will usually need to use these for around four to six weeks.

Ointments and creams should be rubbed gently onto the edge of your eyelids, usually several times a day at first, using either clean fingers or a cotton bud. Once your condition begins to improve, you may only need to do this once a day, usually at night after cleaning your eyelids using the method outlined above.

Oral antibiotics

You may be prescribed antibiotics to take by mouth once or twice a day if your blepharitis does not respond to other treatments. Oral antibiotics may also be recommended at the start of your treatment if it's thought that rosacea is aggravating your symptoms.

Most people respond well within the first few weeks of treatment, although you may need to take them for up to three months. It's important for you to finish the course of antibiotics, even if your symptoms get better.

Treating other conditions

Depending on the suspected cause of your condition and any other symptoms you have, you may also need additional treatment. For example, if you have seborrhoeic dermatitis or dandruff, you may need to use an anti-dandruff shampoo on your scalp and eyebrows.

If you have dry eye syndrome, which frequently occurs alongside blepharitis, you may need separate treatment for this, such as "artificial tear" eye drops.

Complications of blepharitis

Blepharitis is not usually serious, although it can lead to a number of further problems.

For example, many people with blepharitis also develop dry eye syndrome (a condition where the eyes do not produce enough tears or dry out too quickly), which can cause your eyes to feel dry, gritty and sore.

Serious, sight-threatening problems are rare, particularly if any complications that develop are identified and treated quickly.