Blepharitis is a common inflammatory condition of the eyelids characterized by itching, burning, foreign-body sensation and crusting of the eyelids, especially prominent in the mornings. Microscopic examination may show crusting of the eyelashes and red, thickened eyelid margins with dilated blood vessels. Many patients will also have meibomian (oil) gland dysfunction characterized by inspissation (thickening) of the oils and, perhaps, plugging of the glands. There may also be a seborrheic (dandruff) or infectious (usually “staph”) component that contributes to the disorder. Blepharitis is more common in patients with rosacea.
Treatment of blepharitis is multifactorial and often required indefinitely, to minimize or alleviate symptoms. Most patients are instructed to scrub the eyelid margins (eyelashes) gently with cotton-tipped applicators (Q-tips) once or twice daily for a few weeks, then once every two to four days for long-term control. Many ophthalmologists believe that cleansing should be completed with tap water (on the Q-tip) only, although dilute baby shampoo has traditionally been recommended. Warm compresses to the eyelids, artificial tears, and antibiotic or antibiotic-steroid combination ointments are often recommended as well. If the meibomian glands are involved (i.e., plugging is present), then tetracycline antibiotics are often prescribed, perhaps for weeks or months at a time. Tetracyclines cannot be used in children under about 14 years of age, nursing or expectant mothers, or even women who might become pregnant due to the risk of damage to immature teeth and bones with this antibiotic.