It is important to first of all realise that Blepharitis & MGD are both a chronic and a progressive condition. This means that it is not something that can be readily cured, though it can be contained with the help of a variety of therapies, resulting in a reduction of the severity of MGD symptoms and better eye comfort. It also means that it is a condition that is likely to get progressively worse if no action is taken to help it, so the earlier the problem is dealt with, the more the likelihood of success.
Blepharitis Disease can be caused by many factors, and so before deciding on a particular treatment it is advisable that you have an assessment to ascertain the exact cause of your symptoms, so that you can choose the therapy which is most likely to benefit you.
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.
At our Dry Eyes Clinic based in Manchester, we use the most modern technology for the treatment of Blepharitis and have been getting very good results. Modern eye infection treatment gives us the ability to open the glands and re-establish a more normal oil output and improvement of the symptoms and alleviate MSG. This requires a professional assessment of the oil layer thickness and specialized photographs of the glands (called Meibography). This would then be followed by a painless expression of the glands themselves. We make use of a revolutionary technology called the ‘Lipiflow Technology’; this technology is backed by over 25 years of scientific research. With this new technology:
Lipiflow is a Blepharitis treatment and is a very significant technological advanced way of managing evaporative dry eye. With a single procedure, applying a combination of directed heat and pulsatile pressure, many find a single treatment effective in relieving the blockage of their Meibomian glands. The LipiFlow is intended for the application of localized heat and pressure therapy in adult patients with Meibomian Gland Disease (MSG) and Blepharitis. Opening the blocked glands may allow your body to resume its natural production of tear film oil. Just imagine returning to doing the things you enjoy, without worrying about your eyes. We can help you take your first step to Blepharitis relief.
Some treatments could take time and they can be temporary but Lipiflow treatment is very fast and effective. The reason why you have been unable to receive long-lasting relief from the above mentioned ways is because the prescription remedies you've tried haven't been targeting the primary cause of your condition - the blockage of your Meibomian glands located in your eyelids. LipiFlow technology is very effective for those who suffer from Evaporative Dry Eye. Our Practitioner will perform a series of evaluations to determine the reason why you have Blepharitis. You’ll start by completing a lifestyle questionnaire, a brief assessment to determine how your eyes feel on a daily basis.
In the cases of severe symptoms, LipiView Ocular Surface Interferometer will be used to carry out the first test. Lipiview is similar to you undergoing a thorough and complete eye examination. LipiView captures images of the tear film, processing 14 million pixels per second – more than a billion data points in total. This non-invasive process takes less than 5 minutes, and provides our Ophthalmologist with the information to further assess your tear film. With LipiFlow technology, heat is applied to the inner eyelid, mild sporadic pressure is also applied to release lipids from the Meibonian glands that were blocked. This process doesn’t damage delicate parts of the eyes or the glands. LipiFlow makes sure that the lower and the upper eyelids are treated concurrently.
Most, but not all, patients show improvement and even those not improving benefit greatly in preventing further withering of the meibomian glands and progression of the disease.
Heat therapy can help to melt the contents of the gland to alleviate the blockage and allow a better flow of lipid to be produced. Many of you may have tried some of the heat therapies available for home use eg., hot flannels, eye bags, heated bean bags etc. These certainly can be of help, but there are some limitations to their effectiveness. Firstly, they do not maintain their temperature and cool down too quickly to have any sustained effect. Secondly, the heat can only be applied to the outer eyelid and therefore isn’t targeting the correct area where the glands lie. In addition, the eyelid tissue itself, has insulating properties further reducing the effect of the treatment. Now fortunately, with the development of Lipiflow these problems have been addressed. The system applies constant, controlled, directional heat to the inner surface of the eyelid while protecting the rest of the eye with an insulated shield, thus providing precise, thermally controlled, safe heat to the targeted area. This, in addition to the application of pressure, facilitates the release of secretion from the obstructed gland helping to improve the lipid layer and relieve the symptoms of Blepharitis
There is an eyepiece called the LipiFlow Activator that will be placed underneath the upper and lower eyelid, the eyepiece will be shaped in a way that contact with the cornea is prevented. When this is done, all you need to do is lie down on the treatment chair for the treatment procedure which could take roughly 12 minutes. In a clinical study, 32% of patients reported no discomfort and 48% of patients noted awareness of pressure without pain during the LipiFlow treatment.
This procedure, as mentioned earlier, would be performed in our Consulting Room, it is virtually painless and some patients consider it somewhat like a spa experience.
"My life was taken over by Blepharitis syndrome... the most painful experience I have ever had! Now my eyes have improved weekly, the feeling of moisture again is wonderful. The treatment & support I received was fantastic. I have got my life back." (Judith Lockhart)