Your Treatment Choices
For most cases of mild Blepharitis, the first step in treatment is usually over-the-counter substitute tears in the form of drops, gels and ointments. There is a vast array of brands and formulations available, so it can be confusing deciding which to choose. Artificial tear drops provide quick relief with minimal blurring of vision but the effects are short-lived, so they need to be used frequently to get adequate relief, there are some products containing ingredients which are designed to make the drops longer lasting.
Gel-like drops cling to the surface of your eyes so last longer and need fewer applications, however, they can cause transient blurring of your vision.
Ointments for Blepharitis, coat the front surface thereby reducing evaporation of the tears, however, they are best only to be used at night as they can cause prolonged blurring of the vision. Which particular brand or formulation to select is a matter of personal choice – what works for one person may not work for another, so it is often a case of trial and error to find the one that best suits you.
If your condition is more than just occasional and mild, then it is possible that you may need some sort of drops and/or oral medication which are only available on prescription. The purpose of these is to treat any bacterial overload which may be contributing to your condition, to reduce inflammation and to help your body produce better quality tears.
Another option is Punctal Plugs, these small sterile devices are inserted by your eye-care specialist, into the small openings in the lids at the corner of your eyes to block the drainage of the tears. This means the tear film stays longer on the eye hopefully resulting in fewer symptoms. These can certainly benefit some people but they have limited success as they do not treat the root of the problem. They can cause excessive tearing but usually they have to be used in addition to artificial tears.
For most sufferers, the cause of their problem is related to Meibomian Gland Dysfunction. The Meibomian glands are responsible for the production of the protective, outer, oily layer of the tear film, if these glands are not functioning properly then they can become blocked resulting in a poor outer oily layer, leading to excess tear evaporation which causes all the annoying symptoms that you experience.
This problem needs a two-pronged attack to treat it: heat to melt the solidified blockages in the gland, and pressure to expel the melted secretions. A simple home remedy is to apply warm compresses to the closed eyes, in the form of warm flannels or more specialised ‘eye bags’ which can be heated in the microwave. Unfortunately, though they can provide some relief, they are of limited use as most of the heat applied gets carried away by the blood vessels. Also, the heat cannot penetrate the thickness of the eyelid to work effectively enough to fully resolve the problem.
Meibomian gland expression, to clear the glands, can be carried out by some optometrists and ophthalmologists. A forceps type device is used to squeeze the clogged contents out of the Meibomian gland. This can be effective but it can be very uncomfortable especially to those with low pain thresholds, and it does require excellent patient co-operation. For those of you with moderate to severe MSG, you may want to consider one of the recent therapies which have been developed to get to the source of the problem to hopefully provide longer term effective relief.
IPL (Intense Pulsed Light), which has been used in the cosmetic industry for some time, has been developed to treat abnormal blood vessels in the eyelid. This can lead to a reduction in inflammation which can be a cause of malfunctioning of the glands leading to solidification of the contents. This treatment is best used in conjunction with Meibomian Gland Expression. It cannot be used on darker coloured skin types. It needs to be repeated monthly, 3-4 times. It can feel slightly uncomfortable and side-effects of blistering and cheek swelling have been reported, though most disappear within a week.