From the Guidelines
Blepharitis is characterized by both a sandy, gritty feeling in the eyes and soreness/tenderness of the eyelids. This common eye condition involves inflammation of the eyelid margins where eyelashes grow, typically affecting both eyes. Patients often report multiple symptoms including the sensation of something in the eye (foreign body sensation), burning, itching, excessive tearing, crusting of the eyelids, and redness along the lid margins. According to the most recent guidelines, management typically involves a daily lid hygiene routine consisting of warm compresses for 5-10 minutes to loosen debris, followed by gentle lid scrubbing using diluted baby shampoo or commercial eyelid cleansers 1.
Some key points to consider in the management of blepharitis include:
- Warm compresses to soften adherent scurf and scales or discharge and/or warm the meibomian secretions
- Eyelid cleansing, including eyelid massage in cases of meibomian gland dysfunction (MGD) to express the meibomian glands
- Topical perfluorohexyloctane, antibiotics (topical and/or systemic), antiparasitic medication, and topical anti-inflammatory agents (e.g., corticosteroids, cyclosporine) may be helpful in some cases 1
- In-office procedural treatments (e.g., vectored thermal pulsation, microblepharoexfoliation) may also be considered
It's essential to note that blepharitis often becomes a chronic condition requiring ongoing maintenance therapy, as it results from bacterial overgrowth on the lid margins, dysfunction of the meibomian glands that produce oil for the tear film, or a combination of these factors. The optimal treatment regimen often requires persistence and a trial-and-error approach, and patients should be counseled on the importance of regular eyelid cleansing and warm compresses to manage their symptoms effectively 1.
From the Research
Symptoms of Blepharitis
- Blepharitis is characterized by a range of symptoms, including a burning sensation, irritation, tearing, photophobia, blurred vision, and red eyes 2
- Patients may also experience a sandy, gritty feeling in their eyes, although this is not explicitly stated as a primary symptom of blepharitis in the provided studies
- Soreness or tenderness of the eyelids may be present, particularly in cases of anterior blepharitis or meibomian gland dysfunction 3, 2
Clinical Features
- Clinical examination of blepharitis may reveal scurf, telangiectatic vascular changes of the eyelid margin, inspissated meibomian glands, conjunctival hyperemia, punctate keratopathy, cornea vascularization, and ulceration 2
- Patients with longstanding chronic blepharitis may present with hypertrophy of the lid margin, scars, madarosis, trichiasis, and poliosis 2
Treatment and Management
- Treatment of blepharitis typically involves long-term commitment to eyelid hygiene, as well as other treatment options such as topical antibiotics, antibiotic-steroid combination drops/ointments, and preservative-free tear film substitutes 3, 4, 5
- The use of oral erythromycin has been reported as a successful treatment for childhood blepharokeratitis, a condition associated with blepharitis 6