I have had Blepharitis for 15+ years (since 1989?). Doctors had it misdiagnosed for a few of those years. Through the diagnosis of an ophthalmologist, and extensive reading in medical books and the Internet, I have refined the diagnosis. I have had a few related chalazia and Hordeolum (Sty). At one time, due to the tertiary keratitis, my best vision was 20/200 corrected!
Recent Blepharitis attacks have prompted updating of the page (June 1998, August 1999, November, 2004.) Additional information comes from the last two good doctors (one was the first doctor to suggest to me pursuing the root problem instead of just treating the symptoms) in Waverly, Iowa (1998). The second doctor in Davenport, Iowa understands the underlying dynamics of the root cause and the related problem of Acne Rosacea. I am also currently seeing a dermatologist who is dealing with the Acne Rosacea specifically. Between these two most recent doctors, the basic treatment is the same.
For the past few years (2000-2004) I have been symptom free. I cannot really put my finger on anything specific other than perhaps a diet which simply limits or reduces the typical American fast-foot high bad fats/hydrogenated fat diet.
Nov 2004 - It's baaack! Just when you think you have this thing licked like a bad penny it returns. For more of my analysis and further progress in getting to the root cause, see the Speculations on the Root of the Problem section at the bottom of this document.
There are 2 kinds of Blepharitis-- Seborrheic and Bacterial (Staph). (You will find a variety of spellings for Seborrheic on the web). Most people have both. What typically happens is they have Seborrheic all the time with periodic flare-ups of the Staph variety during times of stress when the defenses of the body are weakened. The Seborrheic Blepharitis also creates an environment for the creation of sties, Hordeolum (external type--Sty that are in the sebaceous glands at the base of the hair follicles, or internal type--meibomian glands, and chalazion. Sometimes a Hordeolum or chalazion can go away on its own with the help of moist hot packs. The hot packs increase the blood flow to aid the body in naturally taking care of itself and getting rid of the offending material. The heat can also help liquefy the hardened oils. Sometimes a doctor will surgically drain them for $50 - $100 or so. Shop around for a good doctor and a good price.
I have heard that there is a third type, though I have not done enough research to confirm and comment on a third major type of Blepharitis.
Blurred vision is a side effect of the condition. This is often referred to as kerititis or inflammation or speckling of the cornea. The Staph germs release exotoxins as part of the way they work which eats away at the cornea. This is a side effect, not the real disease-- important. You get rid of the Staph-- you get rid of the exotoxins-- you get rid of the kerititis and the blurred vision. Another source of blurred vision results from the tears thickening to the point where they could be called (my term) eye-sludge. This stuff hangs around on the inside of the lower lid and when you blink, it is spread on the eye, coating it much like one would spray a translucent matte paint on a bathroom window or shower door. It lets light in, but you cannot easily see through it.
Oil is at the base of the problem. When you understand where oil fits into the equation, a whole new approach to treatment and recovery opens for you. Yet, it is important that you do not take this pursuit of reducing or eliminating oil to an extreme. I have heard of one case where the patient used Retin-A to excess and ended up burning out her oil producing glands around her eyes. The result was a permanent case of dry eye. The body's mechanism for the production of tears requires a properly balanced mix of oil and water. When the mix is wrong such as when there is too much oil, too thick of an oil, or impurities are mixed with the oils, the problems of Blepharitis begin to show up.
Some of the other side effects of Blepharitis are the falling out of eyelashes, ingrown eyelashes, and eyelashes that grow inward towards the eye, rubbing against the eye. I experienced for the first time one of these September, 1999. I had thought I had an eyelash in my eye but could not wipe it out of my eye. An extremely close inspection showed an eyelash on the lower lid growing straight up against my eye, up partly over the cornea. Eye sludge had begun to gather around the lash and was therefore causing some blurred vision. A gentle pull by a pair of tweezers (from a Swiss army knife my wife had in the car at the time) removed the eyelash. I now have to do this with this one specific eye lash every few months as it grows back. Since this was a minor surgical operation, I urge extreme caution in performing this procedure. Overall, my upper eyelashes are intact. There are places on my lower lid where I have no eyelashes, thinning eyelashes, and the normal distribution of eyelashes.
Typically, secretions will build up on the eyelashes during the night and sometimes during the day. Clean the eyelashes down to the base 1, 2, or 3 times a day with a cotton-ended swab (Q-tip®). A good time is first thing in the morning when washing the face. Use plenty of water on the eyelids and lashes and soften up the secretions on the eyelashes. After drying the face, immediately use a cotton swab to remove whatever remaining stuff is clinging to the eyelashes.
Some doctors recommend a properly diluted baby shampoo or prepared eye-scrub for this. This can be too much trouble, and the extra chemicals introduced into the eye can cause further irritation and problems. However, recognize that the important element here is oil. Oil and water do not mix. Water is not a good solvent for oil. You need something that will help remove some of the oil. This is where the baby shampoo diluted 1:10 or 1:20 comes in. The diluted shampoo acts like a solvent, but is not so concentrated that it causes irritation. You need a means for removing the oil and soap solution.
A dry cotton swab picks up most of the secretions. You can use a side to side motion, with the eye closed, or you can use a twirling motion kind-of like putting on mascara. The important thing is to remove all of the secretions clinging to the eyelashes and most of the oil. A big mistake most people make with the secretions that stick to the eyelashes is to try to remove these secretions when they are dry. Doing so, can irritate the edges of the eyelids and cause an infection by ripping open the skin, which is stuck to the underside of the dry secretions. Leaving the secretions on the eyelids can also cause ulcers since these particles can be sharp to the eyeball and cornea. The blinking of the eye can wipe these sharp particles across the cornea causing minor scratches and creating an opening for the attack of various bacteria that are just waiting for an opportunity to strike. That is why it is important that you do not rub your eyes in the morning. As soon a possible in the morning, wash and soak your eyes to loosen and remove the dry secretions, which built up during the night. This will greatly reduce the chance of scratches on the eye, which would give bacteria an opportunity to get their foot in the door.
There can be an association with contaminated cosmetics. You might want to consider throwing out all cosmetics at the start of the treatment and begin a policy of periodic replacement of cosmetic containers, particularly of mascara applicators.
You might also want to consider oil-free cosmetics or cosmetics that do not have an oil base. (This may not be possible since I know little about cosmetic chemistry.) With as many Blepharitis and Acne Rosacea sufferers out there, this may be a marketing opportunity for an entrepreneur.
Doctors prescribe various antibiotics to keep the Staph in check. There are some resistant strains, so try various antibiotics until you get one that works (Bacitracin, Tobramycin (Tobradex® which contains steroids), and Polyspolrin are examples) and use it as prescribed so you get rid of the Staph completely. Otherwise, you run the risk of generating a resistant strain that will be tougher and more expensive to wipe out.
I have also heard of oral administration of Doxycycline, tetracycline (note side effects: PERMANENT yellowing of the teeth in younger patients, changes in bowel habits), Erythromycin, and minicycline. The purpose for oral intake is to allow the body's circulatory system to distribute the medicine to where it is needed. Eyedrops do not get absorbed well into the surrounding tissue since the skin has a good defense mechanism built into it. I personally have experienced one course of Erythromycin. I had an allergic reaction in the past to Doxycycline on an unrelated illness.
Tetracycline and Doxycycline have a unique side effect, which is used to the advantage of the Acne Rosacea sufferer. This is a very important point, which doctors and patients often overlook. The reason for using tetracycline is not for its antibiotic properties! Tetracycline has a side effect, which the doctor uses to his advantage. The side effect changes the consistency and activity of the oil producing glands. The result is oil production that does not clog up and harden in the pores, which in turn does not produce as good of an environment suitable for bacteria to multiply and grow. This is the key to dealing with the root problem of the disease. If you deal with the oil, you solve the underlying cause for Blepharitis. At this time, (September 1999,) research cannot explain why Tetracycline works, nor can they explain why the oil production system is malfunctioning. Tetracycline is the only drug that does this and it is really cheap. It is so cheap in fact that you can buy it cheaper than going through the insurance company and messing with $10.+ co-pays. A maintenance dose of merely one 250mg capsule per week does the trick for many people. Some doctors will kick-start this treatment with 1000mg/day and then work down to the 250mg/week dosage. Work with the doctor and aim for the minimal that works for you.
I was (1999) on a on a low-dose maintenance program with oral tetracycline taking between 250mg & 500 mg a day. I worked to get down to 250mg but the disease seems to act up at that low of a level. So I vary taking capsule between 1 per day and twice a day. I do not know if taking the same amount but in smaller doses over shorter periods would be helpful. This might be a method for reducing the total intake of tetracycline. As of Fall, 2003 I am off Tetracycline altogether.
I have heard also of specially prepared Doxycycline eye-drops. Other various treatment medications are: Patanol, Neo/Poly/Dexo drops (contains steroids), minocyn, Dicloxacillin or cloxacillin.
Eye washes: Baby Shampoo, Neutrogena, Ocusoft, "Lid-Care," & "Eye Scrub" Their purpose is to reduce the amount of oil.
Anyone with Acne Rosacea & Blepharitis can try Noritate cream, Tetracycline (see note above) or Doxycycline, and an antibacterial face scrub.
The best type of doctor for this is an Ophthalmologist (not Optician or Optometrist.) Ophthalmologists will charge more, but they know more about treating eye diseases. On occasion, you will find Optometrists who have done additional study on eye diseases. Use an optometrist only if he has a good record of accomplishment in dealing with your specific illness. Be prepared to pay a little more to have the doctor give instructions on ALL of the options and treatments that are now available. (This changes with time and I do not claim to be an expert or to be fully up to date on this.) When you call and shop around, try to find out what his/her success rate is in treating it and curing it (Most will say it is incurable.) If you find one that claims he/she can cure it, make sure this is a NEW or proven treatment, (since the history has been that Blepharitis is only manageable rather than curable.)
Do not let him/her push you around and treat you like a guinea pig experimenting with a variety of antibiotics and scheduling all kinds of return visits. Ask up front what his/her expected plan is (number of visits, results, costs for drugs, etc.) If he can not say, "90% of the time I have cured this with 2 visits or less with antibiotic X" or something to that effect to your satisfaction, move on to another doctor.
Ask the other doctors in town, "Who is the best in treating this?" If your doctor is the best and still not successful, ask who also is doing work in the country or around the world. Get a referral, travel, call, write, send email, or have the other doctor talk to yours. Leave no stone unturned.
There are now doctors who have sub specialties in diseases of the exterior or the eye, eyelids, and cornea. I had opportunity to have an appointment with one for the first time September 1999. She blew all of the previous doctors that I had seen on Blepharitis away. If you can find one who has this level of knowledge, consider yourself blessed.
One doctor only treated the tertiary symptoms (kerititis) using the steroid Prednisolone to reduce inflammation. I have heard of another case where the doctor prescribed methylprednisolone, which may be the same thing. This use of prescriptions containing steroids has a side-effect of causing Glaucoma by increasing the pressure in the eye. It does put the body in high gear to repair the damage to the cornea. The idea is fix the damage before the side-effects kick-in. Be careful with this stuff and use for a short period of time. Another doctor said use of Prednisolone for treating Blepharitis was crazy. Who is right? You do the research and weigh the evidence. By the way, Tobradex® contains a steroid too.
This whole area needs much research and scientific study, to help remove the portion of treatments, which are simply a result of the placebo effect. Do not be fooled. Medical doctors use the placebo effect too. No one on either side of the argument really wants to admit this, but is true. So the question here is what treatment, pharmaceutical, herb, etc. really works over and above a placebo effect, and why does it work? Various sources have suggested the following items as having some promise for effective treatment. I leave further research in this area up to others.
I personally have seen some but limited improvement using water soluble Vitamin A at 70,000IU/day - 105,000IU/day. It seems to make the oils flow freer and thus not clog up pores and the meibomian glands. This has a side benefit of improving acne. This appears to be dealing with the underlying root problem. I have seen some reports that you can safely go up to 150,00IU/day. Do not take my word on this. Research it yourself. Toxicity studies have generally used amounts in the area of 500,000IU/day. The effect seems to diminish at 38,000IU/day. This is different from using Retin-A, which is an externally applied relative of Vitamin-A.
'Tea Tree Oil' is an anti-bacterial and anti-fungal which has given some relief to one person who has contacted me. Two others have reported that drops made from the herb Eyebright have provided some relief. These are treatments of the symptoms and not necessarily the underlying cause.
Eventually the exotoxins will start to hang around underneath the edges of contacts causing erosion of the cornea. Therefore, most doctors will recommend discontinuing the use of contact lenses until the condition is completely clear for a month or two.
The information on the subject has improved over the past couple of years (1996-1999) as people begin to compare notes. If you find anything else that might be helpful to others, please write back. This page continues to expand with current and similar helpful information. If you know of researchers who are working in this area, please send their e-mail addresses.
I have received these two pages from an e-mail response (Jan-2004) as sources that help explain the condition and cover some areas that this page does not. There are some good illustrative pictures and graphics too.
http://www.revoptom.com/handbook/sect1a.htm
http://www.goodhope.org.uk/Departments/eyedept/blepharitis.htm
Blepharitis suffers have essentially a minor autoimmune deficiency coupled with an excessive production of oil. It is minor and troublesome, not like deadly AIDS. The body simply has problems dealing with it. Some might argue against this statement.
My ongoing research focuses on the long-term and underlying problem. My research has led me to believe that there are passive links to oily skin, Acne Rosacea, excema, Psoriasis, high blood lipids, and dry eye. One very interesting item is that the members of Biosphere II who spent a year or two in that bubble in the desert as a side health benefit eliminated their acne. There may be a diet link, but probably it will be a rather complicated one given the current typical American diet. Most people are not disciplined enough to take good care of their bodies to prevent this and other kinds of diseases. It is simply easier to treat the symptoms rather than fixing the root cause.
Nov 2004 - I had started using the homeopathic remedy Similasan® Pink Eye Relief to deal with what I thought to be conjunctivitis in early November. It did make my right eye feel better, but did not really improve anything. Similasan® basically stopped the progression for almost two weeks. I wanted this to improve. I am under a bit of stress from a number of different sources, so I am thinking stress is the cause. So with a very blood shot eye that is not getting any better, (along with another ailment), off to the substitute GP (regular doctor is on vacation) I go. At 13 days into the attack, The GP prescribes Gentamicin Sulfate. Things went from bad to worse. Now I am beginning to see the puffy upper and lower lid and the discharge--the tell-tale symptoms of Blepharitis. So 6 days later, I am at the Opthamologist who prescribed Bacitracin ointment (my old prescription had expired) once each night (worked great at night, but the blurriness of the ointment would drive you nuts in the daytime) and Tobradex® (with the steroid to reduce the inflammation) during the day. During all of this, I am starting to see some interesting new connections. In particular was my personal observation that I have begun of the past few months to continuously ingest dry roasted peanuts as a snack. Just a small handful a few times a day as I am walking through the kitchen. My intentional thought in starting this practice was: this is a good alternative to 'junk food." I am now seeing a connection between the peanut oil and the Rosacea. Thank you Barry Marshall for your personal experimental work in the 1980's with Helicobacter pylori (H. pylori) which helped put me on to this thing. I believe (at least in my case) we can connect the dots between the Rosacea, the peanut oil, and the Blepharitis. Just today, I did another experiment on myself (in the spirit of Marshall) and had two helpings throughout the day of dry roasted peanuts (out of a plastic jar that you buy in the grocery store at $2-$2.50 for a 16oz jar). The ingredient list says, "Dry roasted peanuts." Within 8 hours, here I am beginning to rub my face, scratching at that itching sensation that accompanies the redness of the Rosacea. Bingo! Jackpot! Eureka! I have also been reading lately how people with peanut sensitivities need to continue exposure to the allergen so that they do not redevelop a hypersensitivity. My question now is: how much is too much (for me and my specific situation)? Is this in fact not a sensitivity to peanuts, but a reaction to a common mold that often accompanies peanuts? For the time being, I am discontinuing the peanuts for a while and washing my face more frequently (to clear the irritating oil) until the offending oil clears my system in a few days. I plan to consult with the Opthamologist and my regular GP to pursue this more fully in the weeks ahead.
Early December 2004 - The Opthamologist confirmed the likelihood that peanuts could be the offending agent. He mentioned his frustration in treating patients who go symptom free for months only to have Blepharitis flare up with no apparent warning. He provided lubricating eye-drops to aid in the recovery as the eye continues to clear up. Note the relationship of my latest episode with the case covered in the next paragraph.
1997? - I have had contact with a person who has Blepharitis so bad, that their eyelid edges were flaming red and very painful. Their tear-ducts have greatly reduced their output to the point of perhaps stopping completely altogether (dry eye). This seems to be an extreme case. However, if there were others out there with similar symptoms, I would like to hear about it and share solutions. This person also communicated possible links with Retin-A and 3% Hydrogen Peroxide solution in eyelash dye.
One continually recurring aspect is that of differences between the right and left eyes of the same patient. Many people report only one eye affected, or one eye much more affected than the other. (Such is the case with the Nov 2004 attack where primarily the right eye is affected).
Regarding allergies: some references have been found to: Phenylephrine in eyedrops, and gold.
Again, these are speculations and general observations that I share with the idea that if enough people raise their hand and say, "That sounds like me!" we might be able to narrow down some of the factors which contribute to the disease. This in turn might steer researchers in the right direction for finding suitable long lasting treatments and cures.
Most doctors and eye organizations with a presence on the web, write it off as chronic and incurable-- simply controlled with regular treatment. There may be a monetary incentive for them to say this. I do not buy this incurable stuff. There is an answer out there. There may be multiple solutions so do not write off anyone who is pursuing any avenue of study just yet. At the same time, keep your radar turned up. Look out for con men and other medical quackery that seems to rise to the surface when people get desperate. The challenge is to find the best treatment or better yet, a preventative cure. I am looking. If you can, please help by sending information. In the past few years (1996-99), I have seen a significant increase in the information available, which is directing us closer to a cure. Increased diligence and cooperation on everyone's part will make this a reality.
If this page helped you, please send me a quick e-mail. It always helps to hear from those have been helped by one's work.
Disclaimer: Information on this page is for entertainment informational and instructional purposes only. One should not understand this as medical advice. Consult with your licensed health practitioner. The FDA has not seen this information. Please notify if there are any verifiable inaccuracies presented.
Comments or suggestions: (please no spamm or other time + bandwidth-wasting baloney!)
Last revised 12/3/2004 5:44 PM