blepharitis

Blepharitis: description

An inflammation of the eyelids (blepharitis) occurs when the sebaceous glands clog in the eyelids. These glands lead, inter alia, to the edges of the eyelids. Frequently, bacteria are also involved in such eyelid firing. Because this disease is often white-gray, greasy scales on the edge of the lid, it is also referred to as blepharitis squamosa. If severe, it may progress to ulcerative blepharitis with deeper skin lesions of the eyelid. Overall, the disease is very common and can be treated by regular eye hygiene, lid margin massage and antibiotic eye ointments

Further inflammation of the eyelids

Blepharitis (or Blepharitis squamosa) is the primary concern when the entire eyelid is affected. If it is a narrow swelling of the eyelid, which is not caused by bacteria, but by a blockage of the sebaceous glands, it is called a hailstone. In this one sees no typical signs of inflammation such as redness, swelling or pain. A barley grain, however, is the result of a mostly bacterial inflammation of a sebaceous gland in the eyelid. It is usually quite painful and also shows the typical signs of inflammation.

Blepharitis: symptoms

Many sufferers notice the typical blepharitis symptoms especially in the morning after waking up:

• The eyelashes are often strongly glued after waking up
• The inflamed eyelids are dry and burn or itch
• The eyelids may be slightly red and shed
• The eye creates a foreign body sensation
• Eyelashes increasingly fall on the inflamed lid margin (Madarosis)
• Sometimes fine scales form on the eyelids
• In some cases, the eyelids swell slightly

Blepharitis: causes and risk factors

The cause of blepharitis is an obstruction of the sebaceous glands in the eyelids. Constipation can come for a variety of reasons: people at risk of seborrhoea (seborrhea) are particularly at risk, for example suffering from acne or rosacea. With excessive sebum production, the sebaceous glands clog particularly easily. The clogged sebaceous glands provide an ideal breeding ground for germs. But even external stimuli such as dust, wind, cold, heat, smoke, chemicals or contact lenses can cause clogged sebaceous glands and thus a Lidrandentzündung.

Infectious blepharitis

An infectious blepharitis is usually caused by bacteria (staphylococci), viruses (herpes simplex virus, the chickenpox virus Varizella zoster) or pubic lice. Staphylococci colonize the skin and mucous membranes even in healthy people. In case of a minor injury, they can invade the eyelid skin and cause inflammation. The herpes virus causes the familiar and frequently recurring painful blisters on the mouth. After an infection, it can survive in the nerve endings and later trigger an infection again. If this affects the eyelid, blepharitis can occur.

Pubic lice can be transmitted from person to person in poor hygienic conditions. Most of the time they affect pubic hair, less frequently axillary and whisker hair, and very rarely also the eyelashes (Phtiriasis palpebrarum). The scalp hairs are not affected. As part of a Lidentzündung adhere to the lice of the lice as small grains on the eyelashes. The lice themselves suck on the lid edge between the eyelashes.

Non-infectious blepharitis

The lid margin consists of the outer and an inner portion. At the outer edge of the eyelid are the eyelashes. Inside are the sebaceous glands, whose secretions are given off at the edge of the lid. With the tear film it is distributed with every blink of the eye, so that the eyelid can slide smoothly on the eye. If the sebum production exceeds the normal level, the ducts of the lid glands clog and a scaly blepharitis (blepharitis squamosa) can develop. The excess secretion clogs the eyelashes and forms a greasy coating that can clog the glands additionally and cause inflammation in bacterial or viral colonization.

Blepharitis: examinations and diagnosis

The right contact person for blepharitis is the ophthalmologist. Mostly, he can already make the diagnosis of an eyelid inflammation at first sight. For a successful therapy, it is important to find out whether certain risk factors have favored this Lidentzündung. Therefore, your doctor may ask the following questions:

• Do you have a greasy (seborrhoeic) skin? For example, did you suffer from acne as a teenager?
• Do you suffer from a copper rose (acne rosacea)?
• Have you been diagnosed with atopic dermatitis (dermatitis on dry skin)?
• Do you wear contact lenses?

The ophthalmologist then examines the anterior and posterior lid margins with a magnifying glass. For this he carefully folds the lid. The sebaceous glands (meibomian glands) sitting there can be blocked and inflamed in the case of blepharitis.

With a scaly Lidrandentzündung (blepharitis squamosa) the ophthalmologist can recognize white-gray greasy scales. Deeper skin lesions suggest an advanced inflammation, ulcerative blepharitis. Using a slit lamp, the ophthalmologist can accurately assess whether the cornea (cornea) has been injured by the inflammation. He can also run along the eyelid with a small cotton swab, taking a swab and checking in the lab if the eyelid is colonized with germs.

Blepharitis: treatment

Crucial to the treatment and prevention of blepharitis is a thorough Lidhygiene, This refers to cleansing measures with which the accumulated sebum secretions from the excretory ducts of the sebaceous glands is removed. In addition, the eyelids are carefully cleaned. If a bacterial colonization of the eyelid is suspected or has been detected with a smear, antibiotic eye ointments are useful. Optionally, a treatment of the causative skin diseases is necessary at the same time.

Lidhygiene:

The goal of eyelid hygiene is to ensure a normal drainage of the sebum secretion. This essentially works with two measures: The first important component of eyelid hygiene is the emptying of the excretory ducts of the sebaceous glands. This is achieved by first warming the eyelids (for example with warm compresses, special thermal glasses or infrared light) and then massaging them with clean fingers or cotton swabs. As a result, the sebum secretions are discharged, so that the sebaceous glands no longer clog.

The other important part of eyelid hygiene is the cleaning of the eyelid edges. In blepharitis, the lid margins are often glued or caked. First, so the bonds and crusts must be solved. A damp cloth, hypoallergenic soaps and salicylic oil from the pharmacy can help dissolve the crusts. Subsequently, the eyelids are cleaned with a special cleaning solution or with specially prepared, lint-free cleaning pads. These are available in the pharmacy as special eye care products for eyelid inflammation.

Treatment of infectious blepharitis

If the Lidrandentzündung caused by bacteria, they are treated with antibiotic eye ointments. Only in rare cases should the antibiotic be taken in the form of a tablet. Against Filzläuse pilocarpine oil is used. It inhibits the respiration of the lice, which then die off. They are removed by hand along with their nits. Alternatively, a low mercury ointment may be used in this form of lid margin inflammation.

Treatment of skin diseases

If blepharitis is due to a general skin disorder, it must be co-treated with the attending ophthalmologist, as blepharitis may otherwise return quickly.

Blepharitis: disease course and prognosis

Usually the prognosis of the Lidrandentzündung is good. However, blepharitis can prove extremely persistent. Permanent disappearance of blepharitis in people with excessive sebum production can usually only be achieved through consistent eyelid hygiene.

In the case of a severe course of the disease can develop from the harmless Lidrandentzündung a bacterial blepharitis ulcerosa. The eyelids are often swollen, reddened and overheated. Pus deposits (abscesses) and deeper skin lesions (ulcers) with yellowish crusts belong to this disease. Left untreated, this form of the disease can lead to permanent eyelid misalignment. After all, wound healing occasionally results in scar tissue that warps the edge of the lid towards the outside (ectropion) or inside (entropion). This complication of blepharitis Fortunately, it is very rare.