Definition of blepharitis
Although some variants of blepharitis may resolve spontaneously over a period of 2-4 weeks, most manifest themselves in a chronic form, giving the eyelid a generalized and difficult to heal inflammation.
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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 the experts have not yet accurately demonstrated the causes of the phenomenon, it seems that the onset of blepharitis is linked to the combination of two or more factors. The alleged perpetrators are:
- Bacterial infections sustained in particular by streptococcus
- Viral infections supported in particular by Herpes simplex virus type I (ocular herpes)
- Allergies, including allergic reactions to eye drops, ophthalmic ointments, contact lens solutions and eye cosmetics
- Acne Rosacea: a particular form of chronic dermatitis characterized by the appearance of erythema, telangiectasias and pimples at the level of the face
- Dandruff
- Mites or eyelash lice
- Drug reaction: i sotretinoin (synthetic retinoid used in the treatment of severe cystic acne) can promote the proliferation of bacteria at the eyelid level, altering the mechanisms of production of tears
- Allergic, irritative or infectious conjunctivitis (inflammation of the conjunctiva that degenerates into blepharitis)
Types of blepharitis
There are essentially three forms of blepharitis, distinguished by the nature of the inflammation:
- ULCERATIVE BLEPHARITIS: the cause must be sought in a bacterial infection. The main responsible is the staphylococcus: the infection can originate already in the infantile period and, when not properly treated, continue until adulthood.
- SQUAMOSO OR SEBORROCICA BLEPHARITIS: although the responsible causes have not yet been identified with certainty, it seems that dandruff, acne rosacea and facial seborrhea are more than plausible factors for the appearance of blepharitis.
- HYPEREMIC BLEPHARITIS: manifests itself with generic symptoms such as eyelid edema and hyperemia (red eyes). The cause is often difficult to detect with accuracy.
Symptoms
To learn more: Symptoms Blepharitis
Most blepharitis begins with rather general symptoms, such as ocular and eyelid redness, eyelid swelling, blurred vision, itching and feeling of having sand in the eye.
However, some blepharites manifest themselves in a more evident and recognizable way. In these cases, the patient's clinical picture can be completed by:
- Alteration of the eyelid color scheme: in some patients suffering from allergic blepharitis, a browning of the natural eyelid skin color is observed. For this reason, we speak of "allergic black eye" to indicate a blepharitis dependent on allergies
- Cysts along the edge of the eyelids
- Skin flaking on the eyelids
- Debris in the tear film
- Crusting along the eyelid margin
- Photophobia (light intolerance)
- Typically foamy tear secretion
- Yellow-greenish ocular secretions associated with a "sticking" of the eyelids: a typical sign of infective blepharitis
Generally, patients who use contact lenses have more difficulty coping with blepharitis symptoms: in fact, due to intense eyelid irritation and burning, affected patients are unable to wear lenses for long periods.
Complications
Although it often occurs with typically acute symptoms, blepharitis tends to become chronic. Considering that the disease proves to be rather reluctant to heal, the symptoms can soon degenerate causing serious complications, such as: stye, loss of cilia or alteration of ciliary growth, chalazion (painful cyst that grows in the eyelid due to obstruction of the excretory duct) of the meibomian gland), dry eye / lacrimal hypersecretion and, in some cases, inflammation of the cornea (keratitis) and / or conjunctiva (keratoconjunctivitis).
In ulcerative blepharitis, crusts may form which tend to bleed after removal.
Diagnosis
A suspicion of blepharitis always requires a diagnostic assessment, which is essential for undertaking a specific therapy from the very first symptoms when necessary: by doing so, the possibility of the disease degenerating and becoming chronic is reduced.
The diagnosis of blepharitis begins with the history, that is with the medical evaluation of the symptoms accused by the patient and his clinical history. Afterwards, the doctor proceeds with the eye examination, in which the degree of redness and palpebral swelling is evaluated.
When an infectious blepharitis is suspected, the physician takes a tissue sample (eg, crust) from the inflamed eyelid for a subsequent cytological (cell) 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 (alleged) recovery.
Treatment against blepharitis essentially involves the softening of the crusts and their subsequent (and delicate) removal.
To restrict the healing time, the doctor prescribes an antibiotic treatment for the patient, aimed at removing germs: the antibiotic ophthalmic ointments are the first choice drugs for the treatment of bacterial blepharitis.
When the cause of blepharitis resides in a fungal infection (a rare occurrence), the most indicated 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 benefit in reducing inflammation in a fairly short time.
According to a study reported in the British Journal of Clinical Pharmacology, it appears that some patients with blepharitis may benefit from the instillation of N-acetylcysteine in the eye.
For further information: Drugs for the treatment of blepharitis »
Remedies and precautions
Given the tendency to relapse and the considerable difficulty of 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 kind of infection, including blepharitis. In this regard, it is always recommended to wash your hands, especially before touching your eyes (a habit, the latter, which should be avoided as much as possible). When a family member or cohabitant complains of symptoms related to a potential blepharitis or another ophthalmic infection, the advice is to avoid the promiscuous use of toilet articles, sheets, clothes or pillowcases to avoid any contamination.
It is also recommended to avoid using eye cosmetics during the entire blepharitis therapy.
To reduce the inflammation of the eyelids, some patients benefit from the oral intake of omega-3 in the form of fish oil or linseed oil. As we know, omega 3 helps to rebalance the composition of cell membranes, minimizing the body's predisposition 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 wash eyelids and lashes thoroughly in the morning and in the evening with warm water.
Caution
Softening the crusts with warm-warm water reduces the risk of producing unnecessary bleeding or traumas to the eyelids.
Warm-warm chamomile packs on the eyelids can relieve swelling by exerting a good soothing action: in this case, it is recommended to use a cotton swab or a clean gauze for each pack.
To soften 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 recommended to repeat the operation several times a day.
As an alternative to the infusion of chamomile, it is possible to dissolve 1 teaspoon of sodium bicarbonate in half a liter of boiling water; let the eyelids and eyelashes cool and rub gently with a cotton pad soaked in the solution. Then rinse with fresh water 2 or 3 times.
Even a solution prepared with warm water and mild shampoo 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, Blefarette wipes are very suitable.
Although the remedies described above cannot eradicate root infection / inflammation, they are nevertheless essential for speeding up the healing of blepharitis and improving its symptoms.
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