• What is blepharitis?
• Eyelids and blepharitis
• Treatment
• Lid Cleaning
• Lubricants
• Antibiotic Cream
• Diet and flaxseed oil
• Antibiotic tablets
• Eye lid Scarring
• Other causes of sore eyes &
  Drug treatment causing sore eyes
• healthy diet
• Another blepharitis page (link)
• Blepharitis...a word document for patients

The eyelids have tiny glands in them, especially the lower lids. These glands make substances that mix with tears, and help the tears to spread across the eye.

A cartoon drawing of blepharitis: inflamed eyelids causing a sore eye

As a result, the tears break up, and dry patches develop develop on the surface of the eye. These patches make the eyes feel sore or gritty.

In a very few people the blepharitis can be severe and damage the eyelids, and treatment can prevent more damage occurring.

The treatment is aimed at

1. unblocking the glands in the eyelid, which may be infected and inflamed, like acne on the face or a tiny boil by Lid Cleaning
   
2. replacing the tears if the eyes are dry with Lubricants (dry eyes and blepharitis may occur together: see below).
   
3. treating any infection present with Antibiotic Cream antibiotic cream
4. there are new reports that flaxseed oil is very helpful  and here
   
5. to treat infection and reduce the inflammation using Antibiotic tablets .

The treatment should make your eyes more comfortable, but there is no magic cure. Even with treatment your eyes may remain a little sore, but no harm will come to them and there is nothing to worry about.

Start with lid cleaning, use antibiotic cream if this is not helpful. Tablets are for people with very troublesome sore eyes.

• Dilute some baby shampoo...a teaspoon of shampoo in a pint of water
  
  
• Soak a cotton wool ball in warm (almost hot) water in the dilute baby shampoo. Bathe the eyelids with the cotton wool ball over the closed eyelids for 4 minutes...just hold the ball over the eyelids ...this will loosen any scales on the eyelid
  
  
• Then clean the edge of the lower eyelid with a cotton bud (or the cotton wall ball) to remove scales and debris on the edge of the eyelid.
  
  
• Move the cotton bud/cotton wool ball along the eyelid, using a mirror, and pulling the lid away from the eyeball with the fingers of the other hand. Rub the edge of the lid gently.
  
  
• See a video demonstration.
  
  
• repeat with the upper lid...this is a little harder, but not so important.
  
  
• repeat this at least twice a week

It may be two weeks for any improvement. It is safe to stop cleaning, but you may need to start again if the condition returns.

This product has been recommended by many patients: Lid Care, Novartis http://www.novartisophthalmics.ca/e/products/lidcare.shtml

• gels such as ‘Gel Tears’ or ‘Viscotears’ are usually helpful
  
• drops such as ‘Sno-tears’ may help.
• if the eyes remain sore, preservative-free artificial tears may help. These are particularly useful for people with very dry eyes. Because they have no preservative they can be used more often, even every half-hour, without damaging your eyes. One example is 'Minims'  tears: the ampoules (mini-bottles) contain about 14 drops, and may last a day with practice. They are moderately expensive.

These products are harmless: try and see if they help. You can buy them, but if you need them regularly they can be obtained on prescription.

Sometimes the condition returns once the ointment is stopped, and you may need a repeat prescription from your GP. Some people benefit using the cream intermittently.

Antibiotic tablets are NOT suitable for everyone, particularly if you use several other tablets or have stomach problems. You will need to discuss this treatment with your GP first. Oxytetracycline 250mg twice daily is usually used for 3 months, but not if pregnant.

Alternatives include doxcycline 50mg once daily [or erythromycin].

The benefit lasts several months after the treatment is stopped, but you may need to use further courses if the condition returns.

Severe or persistent blepharitis can occasionally lead to scarring of the eyelid. This leads to lashes growing in towards the eye, which they may rub.

The lashes need to be removed, and there are other treatments if they are a frequent problem. Antibiotic tablets may help to eliminate the blepharitis.

If the eyelids become scarred eyelashes may start to grow in and irritate the eye; they will need to be removed every now and again.

• Your eyes should be checked for other conditions such as glaucoma, by an optometrist; occasionally new spectacles may make the eyes more comfortable.
• Many drugs cause sore eyes. These include losec and zoton for hiatus hernia (these are often unnecessary), antidepressants, and many blood pressure lowering tablets, and frusemide. The more of these drugs you are on, the more sore your eyes. The drugs do not damage your eyes in any way.
• You may have dry eyes (or at least poorly spreading tears) and replacement tears may help, as described.
• You may have an allergy, particularly if the eyes are itchy: try Optichrom or another anti-allergy drop.
• If your eyes remain red and very irritable an ophthalmologist will need to check your eyes in an Eye Clinic. ('Dry eyes' is the most likely cause).
• Blepharitis is not serious; some people whose eyes remain sore have little medically wrong, and are in fact anxious and unduly concerned. Your GP may be able to advise.
• It may seem strange but a healthy diet helps prevent dry eyes and blepharitis.
  • treatment for high blood pressure appears to make the eyes feel dry. A high blood pressure is harmful, and the effect of the drugs (the irritable dry eye) is not harmful, so it is safer to use the drugs. But if you could lower your blood pressure by increasing exercise, reducing alcohol and salt, this would be preferable.
  • omega 3 fats such as those in fish reduce 'dry eyes' by 30-60%. This healthy diet is discussed here.
  • peptic ulcers and hiatus hernias may necessitate proton-pump inhibitor treatment, and these probably make the eyes feel more irritable (my observation)
  • similarly smoking will put blood pressure up and make peptic ulcers and hiatus hernias more common, so indirectly make the eyes more sore
  • a healthy lifestyle is discussed in more detail here

If you are a health professional and want to have a leaflet to give to give to patients, instead of this web page, see (now out of date) 400k Adobe PDF

Alternatively, this is a Microsoft Publisher (updated 2006) document click here, and you are welcome to download it and print copies. You are welcome to make changes for your patients (you can edit the leaflet in Microsoft Publisher).

You will need M Publisher 2000 to open and print the document. M Publisher is bundled as part of Microsoft Office. The only condition is that you let me know if there are any errors.
The document is 550k. The document can be printed out and photocopied to provide a double-sided leaflet 1/3 A4 size for your patients. The address is http://www.diabeticretinopathy.org.uk/leaflets/blepharitisweb.pub