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Itchy, crusty or inflamed eyelids: what can you do to treat blepharitis at home?

"Blepharitis" (inflammation of the eyelids) is an extremely common condition that often has no direct causes, but can be associated with a variety of skin conditions such as acne, rosacea and allergic conditions like eczema. Problems encountered in blepharitis include blockage of small oil-producing glands in the eyelids - "Meibomian gland dysfunction", and dandruff-like material at the root of the eyelashes - "anterior blepharitis". In some people, blepharitis is made worse by sensitivity to a type of bacteria called Staphylococcus which normally live on the skin. In others, the problem seems to be related to an infestation with a microscopic mite called Demodex. All of these can result in inflammation of the eyelids and cause various symptoms including red, inflamed, swollen eyelids, itching and irritation of the eyelids and crusting around the eyelashes. It may also cause sticky eyelids, especially in the morning and styes. Blepharitis can also contribute to dry eyes, which may cause soreness or a gritty sensation of the eyes, sensitivity to light or blurred vision.

Your eye specialist will be able to asses what type of blepharitis you have got (often a mixture of different types) and which treatment is best for you. Certain types of blepharitis such as Demodex can easily be missed if not specifically looked for, but an experienced ophthalmologist will usually be able to spot it and treat it correctly.

In most cases, blepharitis responds well to treatment and is not harmful to the eyes. Hot eyelid compresses and lid hygiene are successful in managing most cases. These should be carried out regularly, twice daily if possible, with clean hands, and usually take a few weeks before the effects are appreciated.

Hot compresses help by melting the oil which is clogging up the openings of the glands. This allows the oil to flow more freely and reach the surface of the eyes, where it helps to keep them moist.

Lid massage: following the hot compress, the application of pressure to the eyelids helps by squeezing out the oils, allowing them to flow more freely once again.

Lid scrubs aim to gently, but physically, remove the crusting trapped between the lashes, as well as excess oily secretions and bacteria from the eyelid margins.*

Watch this space for a new information leaflet which will be available very soon, with further detailed instructions on how to correctly carry out hot compresses and lid hygiene.

Other options which may help include artificial tear drops, which can offer some relief from some of the symptoms caused by blepharitis, although they will not treat the blepharitis itself. Omega-3 supplements such as Flaxseed oil can be purchased over the counter and have been shown to reduce symptoms in some people with blepharitis and dry eyes.

If it is thought that your blepharitis is associated with an overgrowth of Staphylococcus bacteria or an infestation with the Demodex mite, your eye specialist may prescribe an antibiotic and/or steroid ointment or a course of antibiotic tablets. Demodex blepharitis can also respond well to cleaning the eyelids and face with commercially available tea tree oil preparations.**

Occasionally, office-based procedures can be helpful in managing persistent cases of blepharitis which are failing to improve despite good compliance with the measures outlined above.

Unfortunately, blepharitis is a chronic condition, and can therefore recur even after successful treatment. To reduce the chances of this, it is important to continue cleaning your eyelids at least once daily or as necessary to keep symptoms under control.

* Whilst baby shampoo and sodium bicarbonate solutions were commonly recommended for cleaning the eyelids in the past, recent research has shown that these solutions are not as gentle on the eyes as plain tap water or commercially available products designed for use on the eyelids.

**Please seek advice from your eye specialist or pharmacist before applying any products such as tea tree oil to your eyelids, unless they are intended for use on the eyes.

Disclosure of interest: I have no financial interest in any devices or commercially available products for the treatment of blepharitis.

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