Some patients have bacteria (germs) growing on the involved lids. This is not a hygiene issue. In some people, flaky skin builds up on the lashes and this secondarily irritates the eyes.  Common findings in this type of “anterior blepharitis” are scaly skin flakes along the eyelid margins and dried crusts sticking to the lashes. Accumulation of this material causes the eyelid margins to redden, stick together and can alter the growth of the eyelashes or cause lashes to fall out.  When crusts get into the tear film, a gritty sensation occurs that can lead to rubbing, which worsens the already red, irritated eyes.  Sometimes, infection of the lids develops in addition to the “mechanical” irritation caused by the crusting, recognizable by a thick mucoid discharge and “sticky lids” all the time. 


Treatment consists of getting rid of the flakes building up on the lids margin. 


Warm SALT  water compresses followed by scrubs of the lid margin once or twice daily. The salt water soaks/compresses are especially important in this condition.  At the start , you may need to do the compress/scrubs twice daily and once better, you can reduce this to a daily routine.

For a home-made solution, boil 2 cups of water  and add 1  teaspoon of salt and stir to make the solution . Allow the solution to cool  before using this . Once you've made a cleaning solution:
  • soak some clean cotton wool in the solution and remove crustiness from around the eyelids, paying special attention to the eyelashes
  • repeat this process if necessary using a clean piece of cotton wool
  • dip a clean cotton bud into the solution and gently clean the edges of the eyelids by wiping the cotton bud along the bases and lengths of the lashes
  • The scrubs need to performed twice daily . 


If the salt soaks are not helping , then change the formulation to a teaspoon of baking soda to two cups of the boiled water .

You can also consider making your own tea tree oil ( TTO) solution which has been shown to help . Buy 100% pure TTO. Use 1 drop of it in a cup with 2 tablespoons of olive oil.  Then use cotton to dip into the solution and wipe your lashes with the lids closed. This can be quite irritating if you get it into the eyes themselves.  If you tolerate the 1 drop mixture , you can go to 2 drops of TTO with the 2 tablespoons of olive oil.    If you have trouble making this or have issues with irritation you can buy wipes with TTO .  We may start to stock this product from iMED  if there is demand.  The cost likely about $30 for a pack of 60 wipes . Alternatively , you can purchase  Cliradex wipes online  ( $45 for 30 wipes so its quite a bit more )  . 

Periodic use of Ciloxan antibiotic cream - 5 nights  per month- at bedtime - to the lashes ( not into the eye). 
  

 Tear Supplements - Refresh ultra, Systane Ultra  on a regular basis can reduce that scratchy feeling. Switch to a non preserved drop if using these more the 5x day . 


If the eyes are very irritated , a short course of topical steroids is helpful.


I cannot stress enough that the main therapy is the salt water soak and lid scrub.