Welcome to question of the day #120

Welcome to question of the day #120

One of my patients has red, swollen and itchy eyelids on both eyes. She complains of a gritty feeling and that her eyes stick together when she wakes in the morning. How can I help her?

This sounds like blepharitis. There are three types.

Staphylococal caused by bacteria which is found on the skin. In most people this causes no harm but for some it causes a localised infection.

Seborrhoeicis linked to a skin condition where the skin is oilier than normal. Yeast in this oil causes an inflammatory response in some people.

Meibomian is linked to the Meibomian glands just behind the eyelashes. They release oil which makes up the outer layer of the tear film. A problem with the glands and the oil leads to eyelid inflammation.

In most cases, blepharitis is uncomfortable but not serious of life threatening. Complications are uncommon.

One treatment that is often recommended is to apply a children’s shampoo to the lid margins using a cotton bud applicator. This is not my preferred choice. Children’s shampoo is formaulated for children’s hair and scalp not for eye lid margins and eye lashes.

I suggest applying mild warmth through a face cloth soaked in warm water for five minutes or better still a reusable heat bag that is warmed in a microwave and placed over the eyes for five minutes. See figure.

I also recommend cleaning and rubbing with an eyelid wipe that is formulated for the treatment of blepharitis. See figure.

This is a common condition which although rarely has serious eye complications can nevertheless have a large negative impact on quality-of-life through the way it makes the person feel and look. As such it should be taken seriously.