The Blepharitis is Back

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Well, it actually never really left.  But I had a period since mid April where the symptoms seemed to have partially subsided.  My eyelids were not visibly red or puffy and the symptoms were not particularly bothersome.  So I got a little lazy and gradually stopped doing my daily morning and evening hot eye soaks and cleansing routine regularly (earlier post on Sjogren's and Belpharitis).  I know I know -- just because there is some improvement does not mean to stop the routine that helps keep it under control.  What a bad patient I can be.  Subconsciously, I was hoping that the previous 8 months of pretty continuous uncomfortable blepharitis might have vanished.  And I do get frustrated with how long my going to bed eye and medicine routines take so I guess that I just started to slack a little bit.

Yesterday, my right eye was feeling more light sensitive than usual and my eyelid also felt numb (this is often an indication for me).  And this morning when I woke up the lower and upper lids were back to being red, swollen, and achy.  So starting today I am back on my blepharitis control routine.

When I went the eye doctor in May, she gave me a new medication regimen to try for when the blepharitis was particularly symptomatic.  At the time, she saw more inflammation in my left eye than my right, but I wasn't experiencing symptoms so we decided to wait before using it.  Now, I am going to need to start the treatment.

I was prescribed Lotemax steroid opthalmic drops for 10 weeks -- 4 x a day for 2 weeks, 3 x a day for 2 weeks, 2 x a day for 2 weeks, and 1 x a day for 4 weeks.  I had used Lotemax ointment in the past for blepharitis, but only for 2 weeks at a time and each time the symptoms came back almost immediately once I stopped taking it.  With this new routine, I will be tapering the drops similar to what is done with oral steroids to prevent rebound.  I will also have to get my eye pressure checked because steroid drops can cause an increase in intraocular pressure, which can lead to super serious eye complications.

Lesson learned for today.  When something improves, don't stop the routine that helped!

Sjogren's and Blepharitis

Often times when I go to the ophthalmologist, I learn that I have a new eye condition or a previous one has returned.  This visit was no different when I went to the eye doctor earlier this week and found out that the blepharitis affecting my right eyelids has not improved and that it is also affecting my left lids. Blepharitis is a relatively new condition for me and I have learning more about during the last few months.  Since blepharitis is a common condition for those with Sjogren’s, I thought that this would be a good opportunity to share some information about it.

Blepharitis is a chronic inflammation of the eyelids; it is more common in those with Sjogren’s or rosacea.  The meiobmian glands, which make lipids, are found along the base of the eyelids and in some Sjogren’s patients become blocked.   

                                      Picture from the Cornea and Contact Lens Society of New Zealand

According to the Sjogren’s Syndrome Foundation, this can cause “low grade chronic inflammation and bacterial infection resulting in pain and swelling of the lower eyelids.”  Many believe that eye lubricants used by those with dry eyes and Sjogren’s patients may contribute to the meibomian glands becoming blocked and to developing blepharitis.  Tear dysfunction itself in Sjogren’s is also thought to be another cause.

The problem with treating blepharitis can be that it tends to comeback.  Most treatments involve warm soaks and gentle cleaning and massage of the eyelids to open the blocked glands. Dr. Robert Fox from Scripps recommends the following steps to clean the lids:

1.       Make a warm compress by dampening a clean washcloth with water and soaking your eyelid for a few minutes.

2.       Make a solution of 1 teaspoon of Johnson and Johnson no tears baby shampoo in a quart of water.

3.       Use a new warm washcloth and put it in this solution and then put the washcloth over your eyelids (with eyes closed).

4.       Next gently massage the washcloth over your eyes

Your doctor may prescribe medications, a specific cleaning routine, or eye cleansers for you.  My doctor has had me use prescription Tobradex a combination anti-biotic and steroid ointment for when the lids become swollen and painful. For Dr. Fox’s complete discussion and recommendations for blepharitis and Sjogren’s click here. Let me know if you any other suggestions or tips that help you keep blepharitis under control.   Mine seems to keep rearing its head every couple weeks.