Q Do you have any information on an eye condition called blepharitis? I'm told it's common, but nobody seems to know the cause - or the cure. My eye specialist says there is nothing to be done, apart from regular eye baths to keep my eyelids clean. Before I resign myself to having this uncomfortable condition for the rest of my life, I'd like to know all the facts. - JB, Manchester
A Blepharitis is a chronic inflammation of the eyelids and eyelashes that can affect anyone of any age. Symptoms vary, but include itching, burning, crusts around the eyelids, missing eyelashes, inflammation, light sensitivity and watery eyes. It has several causes, including poor eyelid hygiene, excessive oil production by the glands in the eyelid and bacterial infection.
Recurring blepharitis is also linked to food allergies, lupus and acne (ironically, the acne drug Accutane can cause this condition). Occasionally, infectious blepharitis is due to fungi like Candida albicans or Aspergillus fumigatus (a distinguishing feature is granulomas, small nodules common in fungal infections, but not bacterial ones). Blepharitis can even have a viral cause (usually herpes simplex), so a careful diagnosis is an important part of any healing plan.
You have already experienced how stubbornly blepharitis resists treatment. And most doctors only know how to control symptoms with regular eyebaths (often with harsh agents such as baby shampoo), keeping the head and facial hair clean and dandruff-free, and using antibiotic ointments such as bacitracin or erythromycin, sometimes with a course of oral antibiotics (both of which can eventually contribute to resistant organisms). Sometimes, topical steroids are prescribed, but these are not always effective and their prolonged use may result in irreparable eye damage.
Your problem is most likely due to an infection, and all of us carry the staphylococci commonly implicated all the time. If it has prevailed, it's because your ability to fight it off is impaired. So, if you have an underlying immune problem like lupus, acne or a yeast infection, this needs to be addressed first.
Whatever treatment you choose, you need to boost your immunity. Do consider having yourself checked for food allergies as these can lower your immunity. Reducing stress by any means - yoga, exercise, massage, meditation, hobbies - also reaps benefits. Other standard advice for boosting immunity also applies: cut out smoking, alcohol, caffeine and sugary foods, and get plenty of rest.
A visit to a qualified nutritionist may be a good first step. Nutritional therapies for other types of eye infection may be useful in blepharitis. Vitamin A deficiency has been reported in those with chronic conjunctivitis (Int J Vit Nutr Res, 1976; 46: 454-7). Supplements in a range of 10,000 IU daily may prove useful. Similarly, evening primrose oil (1000 mg twice daily) may help as it contains essential fatty acids that aid the production of tears.
Calendula, chamomile, eyebright and comfrey are traditionally used to treat eye inflammation. A compress made from a decoction of eyebright can give rapid relief from the redness, swelling and visual disturbances with acute and subacute eye infections (Weiss RF, Herbal Medicine, Gothenburg, Sweden: Ab Arcanum, 1988). Traditional herbal texts recommend using 15 g of dried herb in 500 mL (16 oz) of water, boiled for 10 minutes. Eyebright can also be taken as a tea along with its use externally.
Both goldenseal and Oregon grape root contain antibacterial berberine, though success with these herbs is anecdotal. Berberine extract in eyedrops has been studied for eye infections such as trachoma (Ind J Ophthalmol, 1982; 30: 69-75; Ind J Med Res, 1982; 76 [Suppl]: 83-8; Ind J Med Res, 1976; 64: 1160-7) and generally found to work, albeit slowly. For blepharitis, you might consider wiping your eyes several times a day with a thoroughly strained decoction or dilute tincture of berberine as well as ingesting it as a tea or tincture.
When using herbs as an eyewash or soak, it is crucial that the preparation is sterile. Making the brew fresh each time and throwing away any excess is best. And be patient - herbal remedies may take months to work.
There is also some evidence that honey, such as good-quality manuka honey, which has a broad antibacterial action, can be applied to the eyelid as you would an ointment. In a study of 102 patients with a range of eye infections including blepharitis, improvement was seen in 85 per cent of cases (Bull Islam Med, 1982; 2: 422-5).
Homoeopathy has a range of remedies for eye infection and inflammation, including Sulphur, Natrum muriaticum, Hepar sulphuris calcareum and Mercurius solubilis. However, it is best to let a qualified homoeopath diagnose you, and choose a remedy to match your constitution and symptoms.
Artificial tears can help with the discomfort, but read the label and buy those that are preservative-free. This is important since a commonly used preservative in artificial tears, benzalkonium chloride, has been shown to cause damage to the cornea (Am J Ophthalmol, 1988; 105: 670-3; Ophthalmology, 1992; 99: 873-8).
While fighting this infection, try to avoid irritants near your eyes. It can be worsened, for example, by make-up (even the hypoallergenic kind), which can irritate the surrounding skin.