Blepharitis

A diagnosis of blepharitis is generally based on a careful examination of the eyelid and eyes. Tests and procedures used to diagnose blepharitis may include:

• Examining your eyes. Your healthcare professional might use a special magnifying instrument to examine your eyelids and your eyes.
• Laboratory tests. In certain cases, your eye might be swabbed to collect a sample of the oil or crust on the eyelid for tests of bacteria. Examination of eyelashes under a microscope can show excess eyelash mites.

Response to treatments generally confirm the diagnosis of blepharitis. If there is no improvement with treatment, particularly in one eye, your healthcare professional may order additional testing to see if the symptoms are caused by an eyelid skin cancer or an immune-system disorder. Other signs of these disorders may include loss of eyelashes or scarring on the film covering the eye, also called the conjunctiva.

Self-care measures, such as washing your eyes and using warm compresses, might be all that's needed for most cases of blepharitis. If self-care measures aren't enough, your healthcare professional might suggest prescription treatments, including:

• Medicines that fight infection. Antibiotics have been shown to provide relief of symptoms that may be related to bacteria colonies on the eyelids. These medicines are available in several forms, including eye drops, creams and ointments. If these medicines don't improve symptoms, you may take an antibiotic pill.
• Medicines to control inflammation. Steroid eyedrops or ointments to treat inflammation are generally used for people who don't respond to other therapies. You may have a prescription for both antibiotic and anti-inflammatory drugs.
• Medicines that affect the immune system. Cyclosporine eyedrops (Restasis, Cequa, others) have been shown to offer relief of some signs and symptoms of blepharitis.
• Treatments for underlying conditions. Blepharitis possibly related to dandruff, rosacea or other conditions might be controlled by treating the underlying disease.

Blepharitis rarely disappears completely. Even with successful treatment, the condition frequently is chronic and requires daily attention with eyelid cleaning.

Self-care measures are the only treatment needed for most cases of blepharitis.

Clean your eyes daily

If you have blepharitis, you'll need to follow a daily self-care routine. You will do the routine 2 to 4 times a day, but the number of times may vary depending on your symptoms. The following steps should be done with separate washcloths or swabs for each eye:

• Apply a washcloth warmed with water over your closed eye for several minutes to loosen the crusty deposits on your eyelids. Reheat the cloth with warm water as needed.
• Firmly but gently massage the eyelids, using a new clean washcloth or a clean finger.
• Immediately use a clean washcloth or cotton-tipped applicator moistened with warm water and a few drops of diluted baby shampoo or a nonprescription eyelid cleanser to wash away oily debris or scales at the base of your eyelashes. You may need to gently pull the eyelid away from the eye to avoid contact with the eye.
• Rinse your eyelids with warm water and gently pat them dry with a clean, dry towel.
• If you have a prescription ointment, cream or eye drop, use it as directed after cleaning your eyes.

Lubricate your eyes

Try nonprescription artificial tears. These eyedrops can help relieve dry eyes.

Control dandruff and mites

If you have dandruff that may be contributing to your blepharitis, ask your healthcare professional to recommend a dandruff shampoo. Using a dandruff shampoo might relieve your blepharitis signs and symptoms.

If your healthcare professional believes an excess of eyelash mites is causing blepharitis, you may be asked to use a tea tree oil shampoo or 50% tea tree oil scrub. You can purchase these without a prescription.

Contact your healthcare professional if you don't see improvement in six weeks. And stop using tea tree oil if it irritates your skin or eyes.

Avoid eye makeup

It might help to stop using eye makeup when you have symptoms of blepharitis. Makeup can make it harder to keep your eyelids clean and free of debris. Also, it's possible that makeup could reintroduce bacteria to the area or cause an allergic reaction.

No alternative medicines have been proved to ease the symptoms of blepharitis. However, a diet rich in omega-3 fatty acids or supplements containing omega-3 fatty acids might help blepharitis linked with rosacea. Omega-3 fatty acids are found in foods such as salmon, tuna, trout, flaxseed and walnuts. More study is needed.

You're likely to start by seeing your primary healthcare professional. You may be referred to an eye specialist, such as an optometrist or ophthalmologist.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of the following:

• Your symptoms, including any that may seem unrelated to problems with your eyelids or eyes, and when they began.
• All medicines, vitamins or other supplements you take, including doses and the reasons for taking them.
• Questions to ask your healthcare professional.

For symptoms related to your eyelids, questions may include:

• What is likely causing my symptoms?
• What are other possible causes for these symptoms?
• What medical conditions can cause this problem?
• What tests will I need?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?
• Can I continue to wear contact lenses?
• Do I need to take special care cleaning my contact lenses and my contact lens case?
• Can I continue to wear eye makeup?
• Will I need a follow-up visit? If so, when?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• Do your symptoms come and go, or do you always have them?
• Are your symptoms worse in the morning or later in the day?
• Have you been wearing contact lenses?
• Have you changed cosmetic brands recently?
• Have you changed soap or shampoo brands recently?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Has anyone close to you had a recent eye infection?
• Have you ever had any eye diseases, eye surgeries or eye injuries?
• Do you have other diseases or conditions?

What you can do in the meantime

Follow the self-care steps 2 to 4 times a day to clean your eyelids. Avoid anything that irritates your eyes, such as eye makeup and contact lenses.