There's loads of treatments out there for Blepharitis & Dry Eyes. Due to the complexity of both conditions, there's (unfortunately) not a 'gold-standard' or one size fits all treatment.
What works for others, might not work for you.
But don't lose hope!
I went to the liberty of sifting through the latest research studies, and systematic reviews (this is a research study of research studies). Like the Inception of research studies.
These reviews provide a great overview of current blepharitis treatments on the market. I'll also provide my own commentary & opinion for each.
Factors You Need To Be Aware Of
Treatment often depends on the following factors:
- The Underlying Cause - Bacterial, Skin Condition, Parasitic, Gland Dysfunction.
- The Location of the Problem - Front of the Eyelid, Back of the Eyelid or Both.
- The Duration of Symptoms - Recent or Longstanding
If you're not sure, make a visit to your healthcare practitioner.
Let's dive into the different Blepharitis treatments:
1) Eyelid Scrubs - The Mainstay Treatment
Pros - No side effects, cost-effective, works on all types of blepharitis
Cons - Requires regular maintenance, takes time, no sustainable relief
Touted by Doctors & Specialists for decades this treatment helps improve eye hygiene. Using cleansing foam, or shampoo, it involves scrubbing the eyelids to remove debris. Washclothes or cottonbuds/Q-tips are often used.
Companies such as Sterilid and OccuSoft have developed their own formulas that include soothing oils and anti-bacterial properties.
Having done this treatment for the past 20 years, I can vouch for the specialised eyelid solutions over baby shampoo. I found baby shampoo tends to dry my skin out.
Scrubs have been shown to improve all types of Blepharitis. A solid cheap option to maintain eye hygiene.
2) Eye drops/Artificial tears - Replenish Those Tears!
Pros - Short-term relief, Convenient, Helpful for Dry Eyes
Cons - May not address underlying problem, Not suitable for all types of blepharitis
Blepharitis & Dry Eyes can go hand-in-hand. Inflammation around the eyelid can impact tear production and the quality of tears. This can cause your tears to evaporate faster than normal.
The most obvious solution is often to replenish tears via eyedrops.
For those who are suffering from blocked glands behind the eye (Posterior Blepharitis/Gland Dysfunction), this may offer short-term relief.
What type of drops are best? There have been reports that Castor-oil-containing eyedrops - are more effective than saline in improving tear function.
This may be due to the fact that poor gland dysfunction means tears don't contain the essential oils. Castor-oil teardrops may help to provide better lubrication.
This is a convenient option for dry eye suffers, assuming the underlying cause (e.g. blocked glands) is being treated.
However, for Blepharitis sufferers with bacterial buildup at the front of the eyelid, this treatment alone will not offer sustainable relief.
3) Warm Compress - Can't Beat The Heat
Pros - Effective on All Forms of Blepharitis, Cost-Effective, Easy
Cons - NONE
The saying KEEP IT SIMPLE STUPID comes to mind with this treatment.
Sometimes you don't need to spend crazy of amounts of money to get great relief.
Warm compress raises the temperature of the eyelid to help transform blocked up fats into liquid. This helps clean out the eye naturally.
Warm compress is also effective and loosening up any debris that may be stuck to the eyelid.
Prior to scrubbing, this can drastically increase the effectiveness of cleaning.
What material should you use? Some Doctors recommend moist heat via warm saltwater soaks with a clean hand towel.
I have found great effect placing a heated up spoon over the eye as it tends to hold heat better.
4) Eyelid Massage - Not The Relaxing Type!
Pros - Helps Unplug Glands, Immediate Results
Cons - Difficult/Not Safe to Perform on Self, Uncomfortable
For Blepharitis & Dry Eye Syndrome caused by blocked glands, an eyelid massage may help.
Eyelid massage consists of pressing the eyelid against the eyeball and milking secretions from the glands.
This is typically performed by a qualified medical practitioner.
Having had this done on myself, I can tell you it's not comfortable and my eyes were red for 3-4 days following.
I recently came across the Eyepeace - which is a tool that offers a way to massage the glands yourself. I haven't tried this - but i'd love to hear others experience and review of the tool.
5) Blinking Exercises - Blink Like No One's Watching!
Pros - Easy, FREE (duh)
Cons - May look like a dufus, Likely not enough on it's own
In our digital age, we aren't blinking as much as we should be.
You reading this now, I bet you've been starring for too long at the screen.
So what's the big deal? When we don't blink our glands aren't stimulated to produce tears. By purposefully blinking you stimulate nerves to allow natural secretion of oil by the meibomian glands.
How much blinking should you do? It's recommended 20x, four times a day.
6) Tea Tree Oil - All Natural Baby!
Pros - Natural healing effects, great for Parasitic Infections
Cons - Irritating in high doses
With both antimicrobial and anti-inflammatory effects, tea tree oil may be effective if you have a Demodex infestation.
These are little mites live on at the base of your eyelashes and can block up the glands. Demodex mites typically inhabit our eyes as we get older.
I've found particular tea tree oils lid scrubs, such as Blephadex have helped reduce the redness around my eyelids.
Just make sure you use a dilated solution as it's very harsh on the skin in high doses.
7) Steroid Creams/Eye Drops - Tread With Caution!
Pros - Immediate short-term relief, beneficial for flare-ups
Cons - Masks the underlying problem, Side-effects, not suitable for long-term use, Can Worsen Some Types of Blepharitis
Blepharitis, being an 'inflammatory' condition - surely an anti-inflammatory cream would be the way to go right?
Well yes & no.
Steroid creams help inflammation , there's no doubt about that. However, there's a reason your body is inflammed - either there's bacteria causing it, or a gland dysfunction.
I have used steroid drops & creams to help when I have a REALLY bad flareup - i.e. I look like a stoned zombie. it's great at reducing the inflammation - but looking at the research and being advised by Doctors - you should only go on them for a SHORT time.
- Infection - since it's disrupting the bodies natural defenses
- Cataract development
- Increased in eye pressure (intra-occular pressure)
- Optice Nerve Damage
Another reason to tread carefully, is that anti-inflammatories typically mask the underlying problem. Kind of like a band-aid solution. Using other treatments in conjunction is a necessity.
8) Antibiotics (Topical & Oral) - The Nuclear Bomb Option
Pros - Excellent way to destroy all Bacteria & Toxins, Very effective for back of the eyelid (posterior) Blepharitis
Cons - Side effects & Interaction with other medications
In the cases where bacteria is causing the inflammation antibiotics could be a good option.
Antibiotics drastically reduce the toxins caused by the Staph bacteria. This can help improve the tear film and reduce the buildup of crusty debris. Because it's difficult to scrub & clean inside the eyelid, this may be effective for posterior Blepharitis.
I was put on a course of antibiotics by my Opthamologist and I had complete resolution of symptoms for 4 months.
Low grade doses and high grade doses both show improvements in blepharitis sufferers.
Be certain to ask your Doctor about this option, as antibiotics can have a number of interactions if you are on other medications.
9) LipiFlow - Expensive, But Effective.
Pros - Provides Immediate Medium-Term Relief
Cons - Very Expensive
LipiFlow is an in-office device that provides heat and stimulates the lacrimal gland, similar to blinking and using warm compresses.
Sessions typically lasts for 12-minutes but can cost $2,000 for both eyes.
However, there is evidence to suggest 1 session provides the equivalent of 3 months worth of lid hygiene practice. 3 months of relief for 1 session certainly is quite impressive.
If you got the money, and not the time for daily scrubbing - this might be a good option for you!
Pros - Effective for dry eyes, limited effect for anterior Blepharitis
Cons - Requires multiple visits, expensive
IPL therapy, has been used predominantly on chronic skin conditions and only recently applied to the eyes. Specifically this can be indicated by dry eye syndrome.
IPL works by stimulating the glands to produce healthier tears. This leads to a significant reduction in dryness and an improvement in redness, pain and vision.
Treatment is typically repeated after 2 weeks, 1 month and then monthly until symptoms have resolved.
Following the laser treatment, anethestic drops are applied, and followed by a firm squeezing of your eyelids to unblock the glands.
With an such an array of treatments for both Blepharitis and dry eye syndrome, it's easy to get overwhelmed.
The take home message is that there is no substitute for good eye hygiene.
Under the guidance of your health practitioner, it might be worth trialing a few combinations of the above treatments, and see which ones work best for you!
Happy Scrubbing ;-)