Blepharitis

I started this blog with pink eye, because pink eye is what everyone knows- and think they have.

The reality is blepharitis is by far the most common cause of conjunctivitis. I see several patients every day with blepharitis.

Blepharitis is caused by a build up of the normal bacteria on the eyelashes. When these bacteria reach a critical level, they cause irritation of the surface of the eye- conjunctivitis that looks like pink eye. Or the bacteria may irritate the oil glands in the eyelids and cause styes.

Treatment of most blepharitis is aimed at reducing the numbers of bacteria on the eyelashes. Sometimes just a singe swipe of the lashes in the bath or shower with baby shampoo is enough (“lid hygiene”). Other times a simple and inexpensive antibiotic ointment applied to the eyelashes may be needed.

If you’ve ever had blepharitis with conjunctivitis or a stye, regular lid hygiene is effective at preventing recurrences- like brushing your teeth to prevent cavities.

One early symptom of blepharitis, before conjunctivitis or styes, is noticing increased crusting (“sleep”) on the eyelashes on awakening. Sometimes during a regular eye exam, the eye doctor may notice collarettes- little crusts at the base of the eyelashes that are specific for bacteria overactivity and recommend lid hygiene to prevent future problems.

These discussions about pink eye and blepharitis describe most cases that I see, but there are some cases that are more complicated and persistent. More about “complicated” cases later.

 

“Pink Eye”

I see many patients who come into the office confident ¬†they have pink eye. Usually they don’t. Pink eye is just one of many forms of conjunctivitis- inflammation of the surface of the eye. Conjunctivitis is like saying you have a dog, but doesn’t tell you whether it is a poodle, cocker spaniel, etc. Pink eye is just one kind of conjunctivitis.

Some patients tell me they have had pink eye several times in the last year. I know right away they don’t have pink eye, since it does not recur that way.

Pink eye is caused by a virus and is very contagious. You probably do have pink eye if you’ve been exposed to someone else with pink eye, or if you have an associated cold (upper respiratory illness or URI). Because it is a virus, pink eye doesn’t respond to antibiotics.

But most conjunctivitis is not pink eye. It is usually blepharitis, which is a build up of bacteria on the eyelashes that spills over and irritates the eye. How can we tell the difference? Sometimes we can’t. So we treat the blepharitis and if the the symptoms clear up in ¬†just a day or two, it is not pink eye and not contagious.

I’ll have a lot more to say about blepharitis later.