Blepharitis

Definition of blepharitis

Blepharitis is a "chronic inflammation of the eyelids, which is distinguished by the appearance of crusts, scales and irritative ulcers along the eyelid margin. Depending on the nature of the inflammation, blepharitis can cause rather modest symptoms or cause obvious eyelid deformities with loss. of eyelashes or altered ciliary growth.
Although some variants of blepharitis can resolve spontaneously within 2-4 weeks, most of them manifest themselves in a chronic form, causing a generalized inflammation to the eyelid that is difficult to heal.

Did you know that ...
The term blepharitis consists of the prefix blefar- (which derives from the Greek, Bléfaron, eyelid) and from the ending -ite, which indicates a generic inflammatory process.

Causes

Although experts have not yet demonstrated the causes of the phenomenon with precision, it seems that the onset of blepharitis is linked to the combination of two or more factors. The presumed responsible are:

• Bacterial infections sustained in particular by streptococcus
• Viral infections caused in particular by the Herpes simplex virus type I (ocular herpes)
• Allergies, including allergic reactions to eye drops, eye ointments, contact lens solutions and eye cosmetics
• Acne Rosacea: particular form of chronic dermatitis characterized by the appearance of erythema, telangiectasias and boils on the face
• Dandruff
• Eyelash mites or lice
• Reaction to drugs: l "isotretinoin (synthetic retinoid used in the treatment of severe cystic acne) can favor the proliferation of bacteria in the eyelid, altering the mechanisms of tear production
• Allergic, irritative or infectious conjunctivitis (inflammation of the conjunctiva that degenerates into blepharitis)

Types of blepharitis

There are essentially three forms of blepharitis, distinguished according to the nature of the inflammation:

1. ULCERATIVE BLEPHARITIS: the cause must be sought in a "bacterial infection. The main culprit is staphylococcus: the infection can originate already in childhood and, when not adequately treated, continue until adulthood."
2. SQUAMOUS OR SEBORRHEIC BLEPHARITIS: although the responsible causes have not yet been identified with certainty, it seems that dandruff, acne rosacea and seborrhea of ​​the face constitute more than plausible factors for the appearance of blepharitis.
3. HYPEREMIC BLEPHARITIS: occurs with generic symptoms such as eyelid edema and hyperemia (red eyes). The cause is often difficult to pinpoint.

Symptoms

For further information: Blepharitis Symptoms

Most blepharitis begins with rather general symptoms, such as red eye and eyelid, swelling of the eyelids, blurred vision, itching and the sensation of having sand in the eye.
However, some blepharitis manifest themselves in a more obvious and recognizable way. In these cases, the patient's clinical picture can be complemented by:

• Alteration of the color of the eyelids: in some patients affected by allergic blepharitis, a darkening of the natural skin coloring of the eyelids is observed. For this reason, we speak of "allergic black eye" to indicate allergy-dependent blepharitis
• Cyst along the edge of the eyelids
• Skin peeling on the eyelids
• Debris in the tear film
• Crusting along the lid margin
• Photophobia (intolerance to light)
• Typically foamy tear discharge
• Greenish-yellow eye secretions associated with a "sticking" of the eyelids: typical sign of infectious blepharitis

Generally, patients who use contact lenses complain more difficulties in dealing with the symptoms of blepharitis: in fact, due to the intense irritation and burning of the eyelids, affected patients are unable to wear the lenses for long periods.

Complications

Although it often presents with typically acute symptoms, blepharitis tends to become chronic. Considering that the disease is rather reluctant to heal, the symptoms can quickly degenerate causing complications, including serious ones, such as: sty, loss of eyelashes or altered ciliary growth, chalazion (painful cyst that grows in the eyelid due to obstruction of the excretory duct meibomian gland), dry eye / lacrimal hypersecretion and, in some cases, inflammation of the cornea (keratitis) and / or conjunctiva (keratoconjunctivitis).
In ulcerative blepharitis, crusts can form and tend to bleed after removal.

Diagnosis

A suspicion of blepharitis always requires a diagnostic assessment, which is essential to undertake, when necessary, a specific therapy from the very first symptoms: in doing so, the possibility that the disease degenerates and becomes chronic is reduced.
The diagnosis of blepharitis begins with the anamnesis, that is with the medical evaluation of the symptoms accused by the patient and his clinical history. Then, the doctor proceeds with the examination of the eyes, in which the degree of redness and swelling is assessed. eyelid.
When an infectious blepharitis is suspected, the doctor takes a tissue sample (eg. Crust) from the inflamed eyelid for a subsequent cytological (cellular) investigation in the laboratory: from this test it is possible to trace the infectious agent that caused the disorder .

Treatment

The cure for blepharitis is not at all simple: it is in fact a problematic disease, which tends to become chronic or recur over and over again after the (presumed) recovery.
The treatment against blepharitis essentially involves the softening of the crusts and their subsequent (and delicate) removal.
To reduce healing times, the doctor prescribes an antibiotic treatment to the patient, aimed at warding off germs: antibiotic ophthalmic ointments are the first choice drugs for the treatment of bacterial blepharitis.
When the cause of blepharitis lies in a "fungal infection (a rather rare eventuality), the most suitable drugs are antifungals to be applied topically, such as ketoconazole.
When the symptoms of blepharitis manifest themselves in a violent way, corticosteroid drugs (to be instilled in the form of eye drops or to be applied as ophthalmic ointment) can undoubtedly be beneficial in reducing inflammation in a rather short time.
According to a study reported in the journal British Journal of Clinical Pharmacology, it appears that some blepharitis patients may benefit from the instillation of N-acetylcysteine ​​in the eye.

For further information: Medicines for the Treatment of Blepharitis "

Remedies and precautions

Given the tendency to relapse and the considerable difficulty in healing, to prevent blepharitis it is necessary to follow the general rules of hygiene and behavior to the letter.

First of all, compliance with normal hygiene rules is essential to minimize the risk of any type of infection, including blepharitis. In this regard, it is always recommended to wash your hands, especially before touching the eyes (the latter habit. which should be avoided as much as possible). When a family member or cohabitant complains of symptoms attributable to a potential blepharitis or to an "other ophthalmic infection, the advice is to avoid the" mixed use of toiletries, sheets, clothing or pillow cases to avoid "possible contamination.
It is also recommended to avoid the use of cosmetics for the eyes during the entire treatment against blepharitis.
To reduce eyelid inflammation, some patients benefit from oral intake of omega-3s in the form of fish oil or flaxseed solium. As we know, omega 3 help to rebalance the composition of cell membranes, minimizing the predisposition of the organism to chronic inflammatory states.
In the presence of blepharitis, it is recommended to keep the eyelids clean and to remove crusts and scales: for this purpose, it is recommended to thoroughly wash the eyelids and eyelashes in the morning and in the evening with warm water.

Attention
Softening the crusts with warm-warm water reduces the risk of producing unnecessary bleeding or trauma to the eyelids.

Warm-warm compresses of chamomile on the eyelids can relieve swelling by exerting a good soothing action: in this case, it is recommended to use a cotton ball or clean gauze for each compress.
To sweeten the crusts, some experts recommend applying a gauze (soaked in chamomile infusion) on the eyelids, leaving it on for 5-10 minutes; for an optimal effect, it is advisable to repeat the operation several times a day.
As an alternative to the chamomile infusion, it is possible to dissolve 1 teaspoon of sodium bicarbonate in half a liter of boiling water; allow to cool and gently rub the eyelids and lashes with a cotton swab soaked in the solution. Afterwards, rinse with fresh water 2 or 3 times.

Also a solution prepared with warm water and shampoo delicate for children can be used to soften the crusts.
When you are away from home, it is advisable to bring cleansing wipes prepared with soothing substances (eg bisabolol) and disinfectants (eg chlorhexidine): for this purpose, the wipes Blefarette they are very suitable.
Although the remedies described above cannot eradicate the infection / inflammation at the root, they are still indispensable to speed up the healing of blepharitis and improve its symptoms.

Other articles on "Blepharitis"

1. Medicines for the Treatment of Blepharitis
2. Blepharitis - Herbal Medicine and Natural Remedies

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