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Itchy Eyes? – Don’t ignore it!
Dr Somasheila Murthy, Head of Service, Corneal Diseases, Consultant, Uveitis Service L.V.Prasad Eye Institute, Hyderabad
Our eyelids have two margins-an anterior margin, which is skin-like and bears eyelashes, and a posteior margin, which is a soft membrane and is devoid of lashes. Blepharitis or Eyelid inflammation is a term used for chronic inflammation of the eyelid margin. It can be divided as two sub-types: Anteriorblepharitis is when the base of eye lashes are affected, either due to build up of secretions and crusts (seborrhoeic type) or due to low grade bacterial infection (staphylococcal type). The second type is posterior Blepharitis which commonly affects the posterior margin where the openings of the meibomian glands are present along the posterior lid margin.
Signs and symptoms:
Patients come with redness of the lid margins, grittyness, foreign body sensation, itching and flaky deposits on the skin of the eyelashes (“dandruff of the eyelashes). Also, the tears might seem frothy or bubbly in nature and of poor quality. Blepharitis that localizes in the skin of the eyelids may cause styes (rapidly appearing painful nodules filled with pus) or chalazia (painless firm nodules). In children, Blepharitis may occur when the child keeps rubbing his/her eye due to poor vision or a requirement of glasses. Therefore, if noted in children, tests to rule out refractive errors should always be performed. Blepharitis commonly presents in younger age and especially the seborrhoeic variety is more common in girls.
The single most important treatment principle is a daily routine of lid margin hygiene and it also helps in recurrences. It is sometimes necessary to soften the lid margin debris using warm moist compress. Mechanical removal of lid margin debris using face wash or gentle baby shampoo is also necessary at times. A moist cotton swab soaked in a cup of water with a drop of baby shampoo may be used to rub along the lid margins while tilting the lid outward with the other hand.
In serious cases, antibiotic ointment like chloramphenicol or sulfacetamide eye ointment is prescribed by the physician. Lid massage to mechanically empty glands at lid margin also helps at times.
Oral doxycycline and occasionally low dose topical steroids can be used. Blepharitis can be chronic and difficult to treat for months together, affecting the patient’s quality of life. These patients may consult various doctors from time to time and yet this simple condition may be missed out. In children, the condition may be an indicator of poor vision.
[This article is written by Dr. Somasheila Murthy, Head of Service, Corneal Diseases, Consultant, Uveitis Service L.V.Prasad Eye Institute, Hyderabad]