The first stage of Dry Eye,
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SCHEDULE AN APPOINTMENTBlepharitis is a chronic progressive inflammatory condition affecting the entirety of the eyelid, including the tear glands.
Signs include flaking and crusting of the lashes, persistent eye discomfort, redness, tearing, and eventually dryness due to the loss of these important glands. Much to the dismay of doctors and patients alike, this condition has historically been very difficult to treat. Frustrated patients resort to scrubbing their eyelids with baby shampoo, using artificial tears, or applying warm compresses. But, these treatments provide only temporary relief from daily pain and inflammation. What has eluded us about blepharitis until now is this: the problem starts long before you see any visible symptoms.
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Blepharitis is frustratingly common. In fact, it is estimated that nearly 80% of all eye care patients had signs of the condition. (1) Symptoms of Blepharitis include the following. The biggest challenge with the disease is understanding why it develops. And because established treatments can´t treat the primary cause of the disease, hundreds of suffering patients follow a predictable pattern of care. They end up hopping from doctor to doctor, because no treatment helps in the long term. However, with new scientific evidence, and treatment devices a permanent fix is now available.
A lid debridement technique that removes years of biofilm accumulation from your eyelids and restores the health of your tear glands.
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The problem starts long
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SCHEDULE AN APPOINTMENTDry eye disease sufferers experience changes in the tear film of the eye. This film is a layer of liquid produced by special glands in the eyelids that keep the eyes well-lubricated and comfortable. But, if tear film production is disrupted and the glands stop working effectively, problems start to occur. Until now, few doctors knew the connection between blepharitis and dry eye disease, but many recognized that the two conditions were often found together.
Current evidence suggests that blepharitis and dry eye are not separate diseases. In fact, blepharitis (eyelid inflammation) is the cause of dry eye disease. Research strongly suggests that dry eye disease is simply a late stage of the overall disease of blepharitis. What´s more, the problem appears to start well before a patient has any idea there´s something wrong, as early as 10 years of age!
Avid gardeners understand that you can remove a weed on the surface, but if you don´t remove the entire root system, the weed will come back again and again. This is also true of dry eye symptoms. Until now, doctors have been unable to address the cause of blepharitis, because they didn´t know what caused it. Now, a groundbreaking theory unlocks the door to more effective blepharitis and dry eye treatment. And it targets the body´s most challenging of foes: biofilms.
Biofilms are produced by bacteria as a self-defense mechanism against our immune system. Their ideal growth environment is moist and nutrient-rich, which unfortunately makes the eyelid margins a primary target! Made of a virtually impenetrable matrix of polysaccharides (long strings of carbohydrates), biofilms will stick to almost anything and are not easily removed once they develop. (2) Until 20 years ago, not much was really known about the roles these structures play in disease. But now, scientists have linked them to a large number of treatment-resistant health conditions, including blepharitis/dry eye disease.
Staphylococcus aureus and
staphylococcus epidermidis are two very
similar strains of biofilm-producing
bacteria found on the eyelids
These bacteria are present all over the body from childhood, and pose no obvious risks to us when their numbers are low. They have evolved a unique system that helps them to sense how large their colony is. This is called Quorum Sensing Gene Activation (QSGA). QSGA ensures they don´t reveal themselves to our immune system if the colony is too small and the biofilm layer is thin. But once the colony multiplies, a thicker biofilm develops and starts to produce toxins. Only now do we start to experience eye irritation and inflammation.
Our immune systems are amazing, but unfortunately, they are not perfect. And the main goal of bacteria is to slip under its radar. In fact, if staph were a spaceship, biofilms would be its cloaking device! Staphylococcus biofilms gradually multiply over time on the eyelid undetected, without any noticeable symptoms. Therefore, we may not know there is anything wrong for many years!
By the time we have blepharitis symptoms, the biofilms have advanced significantly throughout the eyelid. They colonize the vital meibomian glands that produce the oily lubrication for our eyes, and the lacrimal glands that produce the aqueous lubrication, both of which make up the protective tear film that stops our eyes from drying out. This is the key reason why we get blepharitis and why we get dry eye disease.
Bacteria form thin biofilms. They start out on the lid margin but eventually find their way down into the eyelash follicles where they thicken and begin to cause inflammation of the lash bulb, the part that grows our eyelashes. Eventually, the eyelash will become thin, crooked, and fall out. Evidence of folliculitis is crusting (sometimes called "scur") along the lash line. The eyes may feel itchy, swollen, and sore, or be totally asymptomatic.
Biofilms reach the meibomian glands, clogging them, and limiting oil production. QSGA activates, causing the bacteria to multiply and release toxins that trigger a stronger inflammatory response within the glands. There is visible inflammation, discomfort, and gland obstruction, known as meibomian gland dysfunction (MGD) or meibomianitis. Symptoms are redness, irritation, light sensitivity, and paradoxically, watering of the eyes.
As the biofilms continue to advance, they start to affect the lacrimal glands, causing them to stop functioning well. They no longer produce their portion of the tear film (the aqueous portion) effectively. The tear film is severely compromised, resulting in dry, irritated eyes.
With pan-blepharitis, there is chronic inflammatory damage to nerves and tissues in the area. At this advanced stage, secondary problems like eyelid ptosis (sagging) occur, which can limit the visual field. There is persistent dryness and irritation of the eyes.
Biofilm is a great food source for a tiny mite called Demodex. This small creature lives along your eyelashes and causes itching, irritation and generalized discomfort. By removing the accumulation of biofilm, you are removing this tiny pest´s food source. See pictures below
Demodex is a tiny mite that lives along the eyelid in those with heavy biofilm. It can cause itching, redness, irritation and discomfort.
This is a Demodex living along an eyelash. The only way to successfully get rid of this pest is to remove it´s biofilm food source utilizing a BlephEx treatment.
If the Demodex is not removed, it can eventually lead to eyelids that look like this.
If you experience blepharitis and/or dry eye disease, at this point, you may be wondering "why me?" The fact is, the Staph bacteria that cause this disease come in many different varieties or strains and some are simply more aggressive than others and cause earlier, or more advanced disease. Risk factors include the following.
By the time we have blepharitis symptoms, the biofilms have advanced significantly throughout the eyelid. They colonize the vital meibomian glands that produce the oily lubrication for our eyes, and the lacrimal glands that produce the aqueous lubrication, both of which make up the protective tear film that stops our eyes from drying out. This is the key reason why we get blepharitis and why we get dry eye disease.
Are dry eye symptoms impacting your ability to perform daily tasks and enjoying your life in comfort? If you are facing day after day of uncomfortable, gritty dryness, come to Centers for Dry Eye for a comprehensive two-hour education and consultation session with our eye specialists. We offer initial meetings with no physician referral as well as accept physician-referred consultations. During the appointment, we will assess your dry eye condition and provide educational information to help you better understand the cause of your dry eye symptoms.
Depending on the degree of your inflammation, we will be able to recommend the best course of action, and develop a long-term treatment plan that will help you finally get the relief you deserve, and prevent your symptoms from progressing further.
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At Centers for Dry Eye, we care about the health of your eyes. Thats why we provide a 35-minute video for our patients on the causes of dry eye, and the best ways to alleviate uncomfortable symptoms
Watch the entire video in one sitting, and you will get your initial consultation for free! Read the details on our contact page for more information.
Eberhardt M, Guhan Rammohan. Blepharitis. Nih.gov. Published February 16, 2019. https://www.ncbi.nlm.nih.gov/books/NBK459305/
Rynerson J, Perry H. DEBS - a unification theory for dry eye and blepharitis. Clinical Ophthalmology. 2016;Volume 10:2455-2467. doi:10.2147/opth.s114674 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158179/#!po=75.0000
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