Meibomian Gland Dysfunction (MGD) and Anterior Blepharitis are thought to be amongst the leading causes of dry eye disease.  MGD is defined as a blockage or functional abnormality of the Meibomian glands, which are arranged in rows along the upper and lower eyelids.  The purpose of these glands is to provide oil to the tear film and prevent the aqueous (water) layer from evaporating.  With MGD, there is an issue with the quantity and/or quality of the oils being produced and secreted.  The dysfunction of the glands can happen with age, additions or changes in medication, endocrine disorder, contact lens wear, immune system disorders (Sjogrens, Rheumatoid Arthritis), skin disorders (acne rosacea, dermatitis), allergies, seasonal changes, nutritional changes, and for no specific reason at all (idiopathic).

Blepharitis is simply defined as inflammation of the eyelids.  Anterior blepharitis affects the outside of the eyelid and the base of the eyelashes.  The inflammation can result in redness, irritation, and itchiness along the eyelid margin, as well as dandruff-like scales at the base of the lashes.  Blepharitis is caused by bacteria living along the lid margins and can be associated with rosacea, dermatitis, scalp or eyebrow dandruff, allergies, or mite (demodex) infestation.  Anterior blepharitis and MGD (also referred to as Posterior blepharitis) often accompany one another.

As we learn more about the importance of eyelid and eyelash health and its impact on dry eye disease, it has become more apparent than ever that everyone should be practicing proper lid and lash hygiene on a regular basis.  Scrubbing the lashes and ensuring that the tear glands are open and distributing quality tears are essential to maintain ocular comfort, prevent hordeola (also known as styes, or when a gland is blocked with infectious material), decrease the presence of bacteria in and around the eyes, and prevent chronic symptoms of irritation and/or dryness.  Proper lid and lash hygiene should be viewed in the same vein as proper oral hygiene.  We get immense short and long-term health benefits from brushing our teeth, flossing, and using mouthwash regularly.  Similarly, incorporating eyelid and lash hygiene into our routine is essential for prevention of acute and chronic eye health issues.  The 2 primary ways to practice good eyelid and eyelash hygiene are straightforward and easy to implement into daily life:

 

  1. Eyelid Scrubs – The number of scrubbing products on the market, alone, is an indication of how much attention patients and consumers should be paying to their eyelids. From foams to wipes to sprays, there are a bevy of over-the-counter products that can be used to perform a basic “home scrub” of the eyelids.  Like toothpaste, not all of these products are created equal and some are ideal for one patient but not another.  That said, the basic or “original” form of almost any of the products is a great place to start.  Lid scrubs should be performed daily.  Apply cleanser to a warm washcloth, close the eyes, and scrub vigorously, horizontally along the lid margin for approximately 20 seconds.  Repeat for the other eye.  This basic regimen can be reviewed and changed accordingly at your annual eye health examination.

 

  1. Warm Compresses – Several different medicated drops, ointments, and gels have been tested for effectivity in helping express the Meibomian glands in order to keep them open and productive. Ultimately, moist heat has been shown to be the most effective practice for maintaining gland health and patency.  Using a warm, damp towel or washcloth can be effective but the cloth often becomes cold after a very short period of time.  Adding rice to a sock and heating in the microwave for 1-2 minutes will stay warm a bit longer.  For best patient compliance and results, a moist heat eye compress mask is recommended.  Depending on the brand, typical instructions are to heat once in the microwave for 20-25 seconds.  Once a day, apply the compress for 6-7 minutes or longer, as this length of time has been studied and shown to provide the best results.  The masks are typically reusable, self-hydrating (no water needed), and antibacterial.  The routine and frequency can be adjusted as needed at your annual eye health examination.

 

Want more information on Blepharitis, Meibomian Gland Dysfunction, or proper eyelid and eyelash hygiene?  Visit https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/blepharitis?sso=y

 

JARED MOST, OD

Clarity Advanced Eyecare/Solutions Dry Eye Center

 

“Blepharitis.” American Optometric Association. N.p., n.d. Web. 27 Jan. 2017.

“Put the Squeeze on Meibomian Gland Disease.” Review of Optometry. N.p., 16 Sept. 2009. Web. 27 Jan. 2017.