The concept of “blepharitis” unites a large group of diseases of the edge of the eyelids of different etiologies. According to some authors, this pathology affects about 20% of the total number of patients with eye pathology. Blepharitis is a bilateral inflammation of the edges of the eyelids, usually having a chronic course. The pathological process can pass to the conjunctiva, lead to a violation of the properties of tears, aggravate the course of inflammatory diseases of the external parts of the eye and dry eye syndrome.
The main function of the eyelids is protective. Blinking movements of the eyelids distribute tear fluid over the surface of the eye, protecting it from drying out. In addition, meibomian glands are located on the edge of the eyelids, in the cartilaginous plate. They provide the lacrimal fluid with a protective lipid layer that protects the eye from drying out, lubricate the intercostal edge and prevent maceration of the epithelium.
The secret of the meibomian glands ensures the proper movement of the lacrimal fluid, preventing its transfusion over the edge of the eyelid. With obstruction of the excretory ducts of the meibomian glands and a change in the structure of their secretion, chronic granulomatous inflammation — chalazion develops. If stagnation forms in the sebaceous glands, an infection gets into them, and then barley develops.
Causes of blepharitis
There are many reasons that provoke the development of this disease. But one way or another, they all lead to inflammation of the edges of the eyelids. Often the occurrence of the disease is associated with a violation of the gastrointestinal tract and diabetes mellitus. In the presence of such pathologies, the human metabolism is destabilized, and this affects the condition of the eyes.
Often, the eyelids are attacked by Demodex mites, which live in hair follicles, sebaceous glands, and on the skin. Their activity is directly related to the state of human immunity. If the immune system is weakened, ticks begin to develop actively.
Blepharitis occurs in patients with nearsightedness or farsightedness if they do not wear glasses. Since there is no correction of poor vision, the eye muscles are constantly tense. From this they get tired quickly, a person has to rub his eyes with his hands. This contributes to the introduction of infection. Pathological microorganisms can also get into the eyes from the inside. In this case, they are brought with the blood flow from other places where there is inflammation.
Thus, all the causes of blepharitis can be divided into three groups:
- Infectious — more often staphylococcal, viral, the result of exposure to pathogenic microorganisms and immunological reactions to pathogen antigens.
- Parasitic — demodectic blepharitis, pediculosis of the eyelids.
- Non—infectious – associated with skin diseases (seborrhea, rosacea), including allergic, autoimmune forms of dermatitis.
How the disease will develop depends on its etiology. However, it is possible to describe the general principles of the development of the disease by the example of ingestion of staphylococci and streptococci. Most often, these microorganisms become the cause of blepharitis. With the blood flow, viruses and bacteria enter the excretory ducts of the glands and begin to multiply actively, especially against the background of weakened immunity.
It is noted that blepharitis often occurs against the background of chronic diseases of the gastrointestinal tract and is accompanied by a thickening of the secretion of glands. It is especially important to monitor the level of glucose in the blood. In such cases, consultations of specialists such as a gastroenterologist, endocrinologist, dermatologist, immunologist are necessary. The treatment regimen should be comprehensive and include both local treatment and elimination of the causes of this disease. In this case, relapses of the disease can be avoided.
Types of blepharitis
Blepharitis is isolated at the place of localization:
- posterior marginal — the disease affects the meibomian glands, covers the cartilaginous part of the eyelids, in this case, destruction of the conjunctiva and cornea and chalazion can be a complication;
- anterior marginal — the ciliary edge is affected, by origin it is divided into staphylococcal and seborrheic, complicated by the development of barley;
- angular — inflammation develops in the corners of the eyes.
According to the clinical picture , blepharitis is divided into:
- scaly-seborrheic;
- staphylococcal ulcers;
- rear edge;
- demodectic.
Scaly
Symptoms: there is burning, itching and heaviness of the eyelids, a large number of small scales (like dandruff) appear on their skin. The disease is accompanied by a violation of the adaptation of the lower and upper eyelids, chronic conjunctivitis.
Ophthalmosacea
Symptoms: mild dryness, eye irritation, visual disturbances. The disease is similar to the scaly form, develops in the form of dermatological diseases of the face. With a severe form of the lesion, it can lead to other diseases, for example, keratitis. Serious signs of the disease (lesions of the eyelids, sclera and cornea) appear only in 18% of patients.
Ulcerative
Symptoms: sensation of a foreign body in the eye, gluing of the edges of the eyelids, rapid eye fatigue, itching and heaviness. Accompanied by the formation of purulent crusts on the edges of the eyelids, gluing of eyelashes. It may be accompanied by improper growth of eyelashes, the formation of ulcers along the ciliary edge, complicated by barley.
Rear edge
Symptoms: eye fatigue, lacrimation, foamy discharge from the eyes, dryness. Accompanied by redness, thickening of the edges of the eyelids, violation of the secretion of the meibomian glands, accumulation of yellowish-gray secretions. It is often complicated by recurrent chalazion.
Demodectic
Symptoms: intense itching in the eyelid area, intensified by the action of heat, heaviness of the eyelids, foamy discharge from the conjunctiva, the formation of scales, crusts, white muff on the eyelash.
Demodectic blepharitis occurs due to tick-borne lesions of the edges of the eyelids. The demodex mite affects the ciliary follicles and the hair sacs of the eyelashes. In 60% of cases it is combined with demodecosis of the skin. The pathogen is diagnosed in the scraping of the affected skin, with biomicroscopy of eyelashes or in the secret of skin and hair follicles. Ticks are found at the root of the removed eyelashes. In 80% of cases, there is a carrier of ticks without the phenomena of blepharitis or dysfunction of the sebaceous glands. Treatment of blepharitis persists for 3-6 weeks until the end of the tick’s life cycle.
Pediculosis of the eyelids
Symptoms: severe itching without conjunctivitis, bluish spots at the bite site, lice nits. Treatment: mechanical removal of lice and adjacent eyelashes, yellow mercury oxide 1% 2 times a day for 10 days.
Allergic
Symptoms: inflammation of both eyes, swelling, itching of the eyelids, tearfulness, photophobia, pain in the eyes. The disease is often accompanied by conjunctivitis. It occurs due to an allergic reaction of the body to pollen, dust, cosmetics, wool, fluff, medicines or household chemicals. There is a chronic form of this type of blepharitis. In this case, the disease is especially aggravated in the spring and is treated together with an allergist and an immunologist.
Diagnostics
To select a treatment, it is necessary to make a differential diagnosis between different types of blepharitis:
- Bacteriological examination of a smear from the conjunctival cavity with determination of sensitivity to antimicrobial drugs.
- Examination under a microscope of 5 eyelashes from each eyelid. The diagnosis is considered confirmed when larvae are found around the root of the eyelash or six or more mobile mites on the eyelashes, with a smaller number it is considered a carrier.
Treatment of blepharitis
Treatment should combine the elimination of the cause of the disease with local therapy, which is selected depending on the results of the examination.
There is an opinion that the course of the process is aggravated by a change in the properties of the secretions of the meibomian and sebaceous glands, which is accompanied by a violation of immune, metabolic processes. There is a frequent combination of recurrent blepharitis with pathology of the gastrointestinal tract, diabetes mellitus, skin, allergic diseases.
When the allergic cause of blepharitis is established, the patient is referred to an allergist. He, in turn, prescribes allergy tests to establish the exact cause of the allergic reaction.
With chronic blepharitis with thickening of the bases of the eyelashes, the doctor may assume the development of more dangerous diseases: carcinoma, basal cell or squamous cell carcinoma. In this case, the patient will be referred for a histological biopsy.
If a patient has cancer of the eyelids or conjunctivitis, a differential examination of anterior blepharitis is performed.
In this regard, to eliminate the cause of relapses, it is advisable to examine and consult patients with other specialists: a dermatologist, gastroenterologist, endocrinologist, immunologist.
General principles of treatment:
- Treatment of eyelids with alkaline solutions;
- Cleaning the eyelids with antiseptics;
- Instillation into the conjunctival cavity, treatment of the eyelids with antibiotic solutions according to sensitivity, corticosteroids according to indications;
- In the presence of dry eye symptoms — tear substitutes;
- In severe forms of blepharitis, systemic therapy is used, as prescribed by an ophthalmologist, antibacterial, hormonal therapy;
- In the treatment of demodectic blepharitis, in addition to local therapy, metronidazole is used.
Thus, chronic blepharitis is an inflammation of the edges of the eyelids that occurs against the background of metabolic disorders in the body.
When identifying immunological disorders associated with viral and bacterial flora, gastrointestinal diseases, appropriate specialists are involved in treatment.
Prevention
To prevent the disease, first of all, it is necessary to observe the hygiene of the eyelids, thoroughly wash off cosmetics. Minimally touch the eyelids, even with clean hands, in order to avoid infection and injury to the bases of the eyelashes, which can eventually lead to a severe intractable form of blepharitis.
Eyelid treatment should be carried out from the outer edge of the eyelid to the inner with a soft sponge or an ear stick soaked in a solution of furacilin, calendula tincture or pharmacy chamomile.
To prevent the occurrence of blepharitis, fatty, spicy, sweet foods should be limited. Drink more water (the accepted norm is 30 grams of water per 1 kilogram of weight) to avoid thickening of the secretion of the glands of the eyelid. Consume at least 200 grams of vegetables and fruits per day. In autumn (October, November), in spring (February, March), take a complex of vitamins with trace elements.
It is also important to undergo timely treatment in case of diseases of the oral cavity, gastrointestinal tract, because they can provoke the development of blepharitis.
If a patient is diagnosed with chronic allergic blepharitis, it is necessary to avoid contact with allergenic agents, especially in the spring. Women should be more attentive to the choice of decorative cosmetics in order to minimize the possible negative reaction.
Be sure to visit an ophthalmologist at least once a year to check the condition of the eyes. This helps to identify serious diseases at an early stage and begin their immediate treatment. Since many eye pathologies are associated with other diseases (chronic, systemic, etc.), it is also necessary to undergo regular comprehensive examinations.