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Pharmacy technician Vicky is walking back through the pharmacy after her lunch when a customer approaches her.

“Excuse me, I don’t suppose you could recommend a really good moisturiser, could you?” asks the woman.

“Yes, I probably can,” replies Vicky. “Is it for the body or face?”

“Actually it’s for around my eyes,” says the woman. “I’ve tried a few different things, because my usual one wasn’t working, but everything seems to really sting and my eyelids are just so sore. Look.”

She closes her eyes, and Vicky sees that the skin on both eyelids is indeed red and a bit flaky.

“Hmm. Is it worse in the morning? Do you notice any stickiness?” asks Vicky. “And are your eyelids a bit itchy?”

“Funny you should ask that,” comes the response. “Yes to all three. Do you have something in mind?”

Answer

Rather than just having dry skin on her eyelids, this customer may have blepharitis, a condition in which the rims of the eyelids become inflamed. This can lead to redness, itchiness, flakiness and slight swelling, often accompanied by a small amount of discharge, which causes the eyelashes to be a little stuck together in the morning, and a sensation of grittiness in the eyes. The condition usually affects both eyes at the same time and, while it isn’t serious in itself, it does require management in order to prevent complications.

Self care measures are often very effective: cleaning the eyelids of any debris by gently wiping using a clean cloth or cotton bud wet with a very dilute solution of baby shampoo and warm water and repeating this twice daily to start with, then once a day as symptoms improve; applying a warm compress, such as a clean cloth soaked in hot water and then wrung out, to closed eyelids for five to 10 minutes once or twice a day; briefly massaging the eyelids before applying the compress may be beneficial; avoiding eye make-up. 

Note that blepharitis is a chronic condition so needs ongoing maintenance following these steps. Cases that don’t respond should be referred to a GP or optometrist and may require a topical antibiotic such as chloramphenicol or even oral antibiotics.

The bigger picture

Blepharitis is a common condition, usually developing in middle age but also affecting people of every age from children to the elderly. It is associated with a number of other conditions, including dry eye disease, seborrhoeic dermatitis and rosacea, as well as certain medications, notably isotretinoin. There may be an infection at play, or dysfunction of the meibomian glands, which run along the eyelid margin and secrete the fats that are an important component of tears.

As it is a chronic problem, remissions, relapses and exacerbations are common. Maintenance therapy, as previously described, can significantly reduce the number of relapses and their severity. Complications can include the formation of a meibomian gland cyst (chalazion) or a stye (hordeolum), dry eye syndrome, intolerance to contact lenses and conjunctivitis. Severe and long-standing cases can lead to keratitis – inflammation of the cornea, which can cause ulceration, perforation and decreased visual acuity – and changes to the eyelashes and eyelids, for example, depigmentation, loss or misdirection of the eyelashes, and thickening, ulceration or scarring of the eyelids, which can cause them to turn inwards or outwards (known as entropion and ectropion respectively).