Management of blepharitis/MGD
What is Blepharitis/MGD?
Blepharitis/Meibomian Gland Dysfunction (MGD) is a generic term for a common chronic eyelid inflammation usually surrounding the lid margin and eyelashes and the oil-producing meibomian glands. This condition frequently occurs in people who have a tendency towards oily skin, dandruff, or dry eyes. Blepharitis/MGD is not "curable" but is easily managed in most people by treatment. It is not contagious. If left untreated, certain types of Blepharitis/MGD may lead to infection, eyelid or corneal scarring and loss of vision.
What causes blepharitis/MGD?
Everyone has bacteria on the surface of their skin. In some people, bacteria tend to colonize on the skin at the base of the eyelashes or in the meibomian glands. This results in inflammation and structural damage of the lid margin. When meibomian glands become inflamed, oil production reduces in quantity and/or quality which in-turn often leads to an evaporative dry eye.
Warm Compresses and Lid Massages
Warm compresses heat the debris and dried oils on the lid margin to or above the melting point so that they are more easily removed with lid scrubs. Technique: Soak a washcloth in water as warm as the eyelids can stand, wring, and then place the cloth on the lid surface (eyelids closed) for five to ten minutes. Several innovative techiques work well such as use of a fresh-boiled egg (in its shell wrapped in a washcloth)or a small microwaved red potato. Warm compresses should be combined with eyelid massage. This is especially important in patients who have Meibomian gland dysfunction (MGD). Naturally, the oils produced by these glands to help prevent tear evaporation are the consistency of vegetable or motor oil. In MGD, the meibomian secretions are thickened and the gland openings become clogged. Think of a toothpaste tube filled with butter instead of toothpaste. When cold, you will not be able to express the butter out of the tube. However, once you heat it, then the butter will soften enough to come out of the tube, but squeezing on the tube would still be necessary. Using this analogy, after warm compresses of the lids, the thickened meibomian gland secretions are more fluid, but massage is necessary to express them. After every 1 minute of warm compresses, massaging the eyelid as follows will be useful: Gently close the eyelids. Put your index finger on the outer corner of the eyelid. Pull the eyelid towards the ear, so that the eyelids are stretched taut. Next use the index finger of the opposite hand to apply direct pressure to the taut eyelids starting at the inner aspect of the eyelid near the of the nose. Sweep with firm but gentle pressure towards the ear. Repeat this maneuver four to five times. Remember that the goal is to apply gentle pressure to the eyelids - so just rubbing the eyelid surface will do you no good.
There are several ways of performing lid scrubbing. You can choose whichever one you are most comfortable with. The scrubbing should be directed at the base of the eyelashes on the edge of the eyelid. Soaps should not have excessive perfume or lotion content in them. Neutrogena bar soap: This bar soap is used to form lather on the clean finger tips. Lather is then applied with fingertips on the eyelid margin and eyelash bases for up to 1 minute (with eyelids gently closed so that soap does not enter the eye). This is followed by a facial rinse. Johnson's Baby Shampoo: A very tiny trace amount of J & J brand baby shampoo can be applied to a thin, cheap washcloth (baby washcloths work well)and worked in to a lather. To do the bottom lids, pull the lower lid downward while looking upward then gently "scrub" the lid edge back and forth from the inner corner to the outer about a dozen times. A cotton tip applicator may be used alternatively. The upper lid is done by gently closing the lids and simultaneously raising the brow to expose the edge of the lid. Scrub back and forth with the sudsy washcloth as done on the lower lid. Rinse with warm water. Commercially available presoaked cleansing pads such as OCuSOFT Lid Scrubs are preferred over soaps and washcloths.
Newer products incorporate foam for eyelid cleansing such as Ocusoft Plus Foam Eyelid Cleanser or Sterilid Foam Cleanser from Theratears. A small amount of foam is applied to clean fingers which are then used to scrub back and forth directly on the closed lid margins.
Dr. Carver may prescribe an antibiotic ointment or gel forming solution such as AzaSite™ The use of an ointment on the eyelid margin immediately after a lid scrub is sometimes needed to improve comfort and reduce excessive bacteria. The best choice is usually prescription erythromycin eye ointment because it is gentle and effective. Oral tetracyclines (doxycycline or minocycline) for about 3 months can be used in advanced or stubborn cases of MGD. Tetracycline antibiotics improve the meibomian gland secretions by reducing inflammation. They also inhibit bacterial enzymes as well as reduce the eyelid bacterial load.
Use of the oral supplements Omega 3 (cold water fish oils) and certain Omega 6 essential fatty acids can markedly improve MGD and blepharitis. These products are generally good for overall health (skin, joints, cardiovascular system). The most complete nutritional "cocktail" I've found is BioTears by Biosyntrx which can be ordered directly from the company or can be purchased in our office.