I remember the time my ophthalmologist told me I had blepharitis. "Blephar-what?" I asked. It turns out that blepharitis is a condition that lots of us have but that most of us know very little about.
What Is Blepharitis?
Like any other -itis, blepharitis is a condition of inflammation. Blepharitis is a condition of chronic inflammation of the eyelids. The first thing you notice may be that your eyelids seem to be stuck together when you wake up in the morning. You can have bouts of blurred vision that don't have any discernible cause, only for them to go away when you blink. Inflammation of the eyelids can trap eyelashes against the eyeball. And you can have itchy, burning, painful eyes that are sensitive to light.
Blepharitis is caused by excessive activity of the bacteria that recycle the oil the eyes produce to keep the eyelids lubricated. It is worse when seborrheic dermatitis causes excess oil production, but it can occur even when the oil glands at the corners of the eye are secreting sebum normally.
People who are over 50 who have fair skin are more likely to have seborrheic dermatitis as a contributing factor in blepharitis, but this condition can occur in males and females of any race and any age. Epidemiologists estimate that about 20% of the population has blepharitis at some time during life, and it is the most common complaint in ophthalmologists' offices in the US. Left untreated, blepharitis can be more than a nuisance. In the worst cases, the eyelids can become permanently folded in or folded out, and the lens of the eye can be scarred. Blepharitis is unlikely to cause blindness, but the eye irritation and dryness associated with it can become permanent, or need surgical correction.
What Can You Do About Blepharitis?
The most important step in getting rid of blepharitis is consistent daily hygiene. The first step in daily eye care is loosening the crusts that stick to the eyes, eyelids, and eyelashes. Do this by applying a warm (never hot), moist, clean cloth to the eyes for 60 seconds to dissolve dried mucus. Then use a soft washcloth or gauze pads to remove yellow matter from the eyelids, not the eyes themselves.It is important to be gentle, so that the outside of the eye is not scratched or perforated, forming an entryway for serious infections. After cleansing, you apply any ointments your doctor may have prescribed. It's critical to cleanse the eyes before using any antibiotic ointment, because if you don't cleanse your eyes first, you are medicating the mucus, not your eyes. Of course, you need to wash your hands before you cleanse your eyes. It is also important to use a fresh washcloth every time you cleanse your eyes and to throw away used gauze, to avoid reinfection. Some doctors tell their patients to add a few drops of baby shampoo to the water used to moisten the cloth used to moisten the eyes.
The key here is to add one drop of baby shampoo to a few drops of warm water. Too much baby shampoo can create an additional problem when excess shampoo dries on the eyes. Personally, I never used shampoo on my eyes. I used a product called OcuClenz, which saved having to measure shampoo carefully to keep from using too much. It is important to keep the eyes moist throughout the day to avoid infections. The advantage of artificial tears over pure moisture is that the artificial tears include a fatty acid component that helps tears adhere to the eye. The eye naturally secretes an extremely thin lipid layer that keeps tears from falling off the surface of the eyes. If you have seborrheic dermatitis or rosacea, your eyes may be producing too much or too little of this component of natural tears. In these conditions, fish oil can be helpful.
Fish Oil for Blepharitis
I've been asked whether one opens a fish oil capsule and pours the contents into one's eyes. The answer is no. Fish oil supplements are to be taken by mouth. It only takes about 1,000 mg of essential fatty acids (what you would get from 2 or 3 capsules of New Vitality or Xtend-Life, or 5 or 6 capsules of Spring Valley fish oil) to reduce the formation of inflammatory hormones.
Taking fish oil can make a difference in itchiness, burning, and sensitivity to light in about two weeks, although these symptoms may not completely disappear. Along with using fish oil, it may also help to reduce consumption of meat, cheese, and eggs. Some naturopathic physicians believe that these foods, especially frozen fish and "stinky" cheeses, break down into the biogenic amines cadaverine, spermidine, and putrescine in the bowel.
The biogenic amines circulate through the bloodstream to the skin and they eyes, where they interfere with the metabolism of the tear glands and cause formation of tiny bumps on the surface of the eyes. How can we know that fish oil really relieves blepharitis? Dr. Marian S. Macsai of Northwestern Medical School in Chicago ran a one-year study comparing the benefits of flaxseed oilversus a placebo for treating adults with blepharitis. She found definite benefit in symptoms from increase omega-3 essential fatty acids in the bloodstream in her patients, but that there was a treatment threshold for symptomatic improvement. Tiny amounts of omega-3 essential fatty acids did not help, although higher amounts of omega-3 essential fatty acids did. I suggest that fish oil, because it contains more omega-3's in the form the body can use than flaxeed oil, is probably a better supplement. The clinical data, however, support the use of flaxseed oil, and report some benefit from taking four or five 1,000 mg capsules a day.
Other Supplements for Blepharitis
There are some other supplements that are also helpful. Young children often respond well to the B vitamin biotin. The reason biotin supplements are helpful in young children is that the vitamin is synthesized by friendly bacteria in the colon, and young children simply have not have enough time for their digestive tracts to host the bacteria that make the vitamin. Sometimes biotin is all that is needed, in addition to daily hygiene, to take care of blepharitis in a small child.
Children should be given 3 mg of biotin twice a day for two weeks. Children 4 and older, teens, and adults often respond to taking supplemental folic acid, vitamin B6, and vitamin B12. This usually reduces the production of sebum, making the eyelids less sticky when you first wake up in the morning. Take a "complete B" supplement and 4 or 5 mg of folic acid every day. Folic acid interferes with the body's ability to absorb zinc from food. If you take folic acid supplements, you should also take supplemental zinc, but just 15 to 30 mg of zinc per day.
A Honey of Treatment for Blepharitis
In the Middle East, honey applied directly to the eyelids is a traditional treatment for blepharitis. In the United States, this treatment has been promoted by the ophthalmologist Dr. Mark Elder. Honey is applied directly to the lids, not the eye itself, and allowed to stay on the lids for 3 hours. Then it is washed off with warm water.
A clinical test in the United Arab Emirates confirms that this treatment works for adults who have seborrheic dermatitis. Completely clearing up the condition, however, required 2 or 3 treatments a week for a full month. The kind of honey you would use is "medicinal grade," that is, it has been gently pasteurized to make sure it is free of bacteria and fungi. Wash and dry your hands before applying the honey to your eyes. Manuka honey is medicinal grade, as are "jellybush" and "Leptospermum" honeys. These kinds of honey contains ingredients that prevent the formation of eye-irritant peroxides that can cause itch, redness, burning, and sensitivity to bright light.
Other Suggestions for Keeping Blepharitis in Check
In addition to these treatments, some adults who have seborrheic dermatitis benefit from vitamin B6 (pyridoxine) creams applied to the eyelids at night. These creams are often prescribed for treating seborrheic dermatitis elsewhere on the body, and they generally don't work on the face, arms, hands, neck, and trunk. They usually clear up "sticky eyes," however, in less than two weeks. It is also important to avoid using eye makeup when you have blepharitis.
Makeup applicators can carry bacteria and infect the entire bottle. Eye shadow and eyeliners can trap bacteria against the margins of the eyelids, ensuring ongoing infection. Most users of cosmetics should abstain for about six weeks even after symptoms go away. All your efforts to treat blephartitis can be thwarted by certain medications. Artane (L-dopa) for Parkinson's disease, hydrochlorothiazide diuretics ("pee pills") and Lasix (furosemide) for high blood pressure and congestive heart failure, isoniazid (INH) for tuberculosis, pencillamine for rheumatoid arthritis, and oral contraceptives can all cause blepharitis as a side effect. If you take any of these medications and you experience sticky eyelids, burning eyes, itchy eyes, and sensitivity to bright light, speak with your physician and pharmacist about alternative treatments.