Blepharitis Treatment in Singapore

What is blepharitis?

Blepharitis is inflammation of the eyelid margins — the delicate area where your eyelashes and the openings of your oil glands are located.

It is extremely common and is often associated with dry eye.

Some people notice obvious redness or crusting. Others simply describe eyes that feel tired, gritty, itchy, watery or uncomfortable, particularly towards the end of the day.

You may also notice:

• redness along the eyelid margins

• flakes or crusts around the eyelashes

• burning, stinging or gritty eyes

• itchy eyelids

• watery eyes

• swollen or tender eyelids

• recurrent styes or blocked oil glands

• fluctuating or intermittently blurred vision

• contact lenses becoming increasingly uncomfortable

The important thing to understand is that blepharitis is not always simply an eyelid hygiene problem.

Why does my blepharitis keep coming back?

This is one of the questions I hear most often.

Blepharitis can have several underlying causes, and more than one may be present at the same time.

Meibomian gland dysfunction

Along the edges of our eyelids are tiny oil-producing glands called the meibomian glands.

Their oil forms an important part of the tear film and helps prevent our tears from evaporating too quickly.

When these glands become blocked or produce poor-quality oil, the eyelid margins can become inflamed and the tears become less stable.

This is known as meibomian gland dysfunction (MGD) and it is one of the common reasons I see blepharitis together with dry eye.

Demodex

Demodex are microscopic mites that can live around the eyelashes and oil glands.

Small numbers may cause no problem at all. When they become excessive, however, they can contribute to inflammation, itching and characteristic debris around the base of the eyelashes.

If Demodex is contributing to your blepharitis, simply using lubricating eye drops is unlikely to address the underlying problem.

Ocular rosacea

Rosacea does not only affect the skin.

It can also involve the eyelids and the surface of the eye, sometimes even in people who have relatively subtle facial symptoms.

Ocular rosacea can be associated with inflamed eyelid margins, meibomian gland dysfunction and persistent dry eye.

Allergy and inflammation

Itchy eyes are often assumed to be allergy alone.

In reality, allergy, blepharitis and dry eye can overlap. Rubbing irritated eyes can make matters worse, and chronic inflammation around the eyelids can perpetuate the cycle.

This is why I prefer to examine the eyelids and ocular surface rather than simply treating every itchy or red eye in the same way.

Blepharitis and dry eye are closely connected

Your eyelids and your tears work together.

Every time you blink, the eyelids spread a new layer of tears across the surface of the eye. The meibomian glands within the eyelids provide the oily component that helps those tears remain there.

When the eyelid margins and meibomian glands are unhealthy, the tear film can become unstable and evaporate too quickly.

This is why treating the eyelids can be an important part of treating dry eye.

Sometimes the problem isn't that you need more tears. It is that the tears you have are disappearing too quickly.

When eyelid wipes and eye drops are not enough

Eyelid hygiene certainly has a role in managing blepharitis.

But if your symptoms repeatedly return despite warm compresses, eyelid wipes and eye drops, I think it is worth looking more closely.

At The Eye Clinic by Dr Cheryl Lee, we examine the eyelids, tear film and meibomian glands to understand what is driving the inflammation.

Treatment is then selected according to what we find.

I don't believe in simply adding more eye drops when we haven't first understood why the eyes are uncomfortable.

— Dr Cheryl Lee

How I treat blepharitis

There isn't one treatment that is right for every patient.

Treatment depends on whether the main problem is inflammation of the eyelid margin, blocked meibomian glands, Demodex, allergy, ocular rosacea, dry eye — or a combination of these.

Your treatment programme may therefore include one or more of the following.

Professional eyelid cleaning

When there is significant debris, bacterial build-up or inflammation around the eyelashes, professional eyelid cleaning can remove material that is difficult to clear effectively at home.

We use BlephEx when appropriate to clean the eyelid margins and the base of the eyelashes.

Treatment of the meibomian glands

If the oil glands are blocked or not functioning properly, treating the glands themselves may be more useful than continually adding lubricating drops.

The aim is to improve the quality and flow of the natural oils that protect your tears from evaporating.

Eye-Light for blepharitis and meibomian gland dysfunction

For selected patients, blue and red light with Intense Pulsed Light (IPL) may form part of treatment, particularly when blepharitis is associated with meibomian gland dysfunction, inflammation or ocular rosacea.

Eye-Light therapy

Eye-Light combines technologies designed to address particular forms of meibomian gland dysfunction and dry eye.

Again, the important part is not the machine.

It is knowing why we are using it.

A home programme that you can actually maintain

Treatment in the clinic is only one part of managing chronic blepharitis.

We will also show you how to look after your eyelids at home and recommend the products that are appropriate for your particular eyes.

I prefer a routine that is effective and realistic enough to become part of everyday life.

Do eye drops cure blepharitis?

NO, that is not addressing the underlying eyelid problem.

This is why someone can use eye drops several times a day and still wonder:

“Why are my eyes still dry?”

Can blepharitis be cured permanently?

Blepharitis is often a chronic condition.

For many patients, the more realistic goal is not to promise that it will disappear forever, but to identify the factors causing the inflammation, treat them appropriately and keep the eyelids and ocular surface healthy over the long term.

Once patients understand why their blepharitis keeps returning, managing it often becomes much easier.

Is blepharitis contagious?

Most forms of chronic blepharitis are not considered contagious.

However, red or inflamed eyes can have many causes, including infection. If an eye becomes suddenly very red, painful, light-sensitive or develops significant discharge, it is sensible to have it examined rather than assuming it is simply another episode of blepharitis.

Can Demodex cause blepharitis?

Yes. Excessive numbers of Demodex mites can contribute to inflammation around the eyelashes and eyelid margins.

There are characteristic signs that we can look for during an examination.

When Demodex is an important part of the problem, treatment should specifically address it rather than relying only on lubricating eye drops.

When should I see an eye doctor for blepharitis?

If you have occasional mild symptoms that settle with simple eyelid care, you may not need specialist treatment.

I would suggest having your eyes examined if you have persistent or recurrent symptoms, particularly if you have already tried eye drops, warm compresses or eyelid wipes without lasting improvement.

You should also seek an eye examination if you experience significant pain, light sensitivity, reduced vision, marked swelling or an unusually red eye.

Persistent blepharitis deserves a closer look

If your eyelids remain red, itchy or uncomfortable despite everything you have tried, the next step may not be another eye drop.

It may simply be time to understand what is causing it.

At The Eye Clinic by Dr Cheryl Lee in Singapore, we assess blepharitis as part of the health of the entire ocular surface — including the eyelids, meibomian glands, tear film and dry eye.

Because once we understand the cause, we can treat it much more intelligently.

Dr Cheryl Lee
Ophthalmologist

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