Conditions: Blepharitis & Dark Circles

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What is blepharitis?

Blepharitis is a very common inflammation of the eyelids. Bacteria which normally live on our skin are attracted to crusts around the base of the eyelashes and produce chemicals which irritate the eyes causing symptoms of itching, irritation and burning. Special tear glands, called meibomian glands, which are located in the eyelids, become blocked. Since these glands help to make our tears and prevent them from evaporating too quickly, blepharitis results in the production of abnormal tears. This is not a lack of tears, but tears which are of poor quality. Blepharitis is often associated with skin problems such as dandruff and dermatitis.

Severe blepharitis

How do I know if I have blepharitis?

The edges (rims) of the eyelids are red and the eyelashes are stuck together by tiny crusts. The whites of the eyes are often red and sore. In the mornings the eyelids stick together, sometimes with a yellow discharge.

These changes cause the eyes to be sore and irritable, with a gritty foreign body feeling. Watering due to the reflex production of excess tears is common.

Is it serious?

No, it is not serious, and only very rarely causes any permanent damage to the eyes. However, blepharitis is a very persistent problem. (Blepharitis which is confined to the eyelid(s) on one side only should however be viewed with suspicion as very rare tumours can mimic blepharitis and lead to misdiagnosis).

Can it be treated?

Yes, though treatment usually can only control the problem and cannot eradicate it altogether.

What is the treatment?

The chief treatment is massage of the eyelids, using soft pads and hot water.

You should buy some cotton pads or balls. You can obtain sterile cotton wool from http://www.faceandeyeshop.co.uk/product_detail.cfm?id=26

Boil up some water and pour the water into a bowl.

When the water has cooled enough for you to be able to touch it without burning your skin, but before it is cold, soak a pad in the water and press it firmly against your closed eyelids.

You will need to press quite firmly, for about a minute.

Finally, use the pad to stroke your eyelashes, in an up-down then side-to-side manner.

Better (but more expensive) wipes which are specially designed for this purpose are called “Blephaclean wipes”. You can order these from: http://www.faceandeyeshop.co.uk/product_detail.cfm?id=2

What is the purpose of the hot water massage?

The hot water melts the tears stuck in the blocked up tear glands. Along with the pressure, this helps to unblock the glands, so that your tears become normal.

A much better solution is the use of the “Eye Bag” which is specially designed to improve meibomian gland function and to sooth the symptoms.

You can order an “Eye Bag” from: http://www.faceandeyeshop.co.uk/product_detail.cfm?id=4

How often should I do this?

Depending on how bad your blepharitis is, you may need to massage the eyelids up to twice a day regularly.

Is that all I have to do?

In addition to regular massage, an antibiotic ointment e.g. Chloramphenicol, rubbed into the lashes at night, can clear the infection. A course of ointment, usually for a month, can be repeated several times a year. Ointments/drops containing steroids should not be used unless prescribed by an ophthalmologist.

Since blepharitis causes tears to be abnormal, artificial tears can give relief from irritation, even when your eyes are watering (eyes can water as a reflex reaction to a basic dry eye problem or tear film abnormality). These should be used 3-4 times a day at least to prevent symptoms rather than to just relieve symptoms. There is a large variety of artificial tear preparations to choose from:

Preservative free: Hyabak drops, Celluvisc, Minims artificial tears, Systane drops preservative free, Viscotears preservative free, or Liquifilm tears preservative free (these are all more expensive but should be used when artificial tears are required more than 4 times a day or where there is a known allergy to preservatives). Some of these can be ordered from: www.faceandeyeshop.co.uk (eye products).

With preservatives: Systane, Viscotears, Hypotears, Liquifilm tears, SNO tears, Optive,
Lacrilube ointment is very effective, particularly when used at bedtime but it can cause blurring of vision in the morning. This can also be ordered from www.faceandeyeshop.co.uk (eye products).

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Dark Circles  

Tear Trough  Restylane Injections

This quite new non-surgical treatment is appropriate for some patients with lower eyelid dark circles/dark hollows (also referred to as tear troughs). In the lower eyelid a weakening of the supporting tissues, and in the cheek area (the mid-face) a loss of soft tissue, tend to highlight the appearance of the bony rim of the eye socket which lies between the lower eyelid and the cheek. This also leads to the appearance of lower eyelid fat pockets (eye bags) and together these can lead to a tear trough, dark circle or shadow as seen in the photos. 

Lower lid dark circle (tear trough)

Not all patients who complain of lower eyelid dark circles or tear troughs are suitable for surgical improvement, usually in the form of a lower eyelid blepharoplasty, cosmetic eyelid surgery or eye bag removal. The use of tear trough Restylane injections offers some patients a less invasive alternative treatment for their problem. It is not suitable, however, for patients who have very loose skin in the lower eyelids or very pronounced eye bags. Such patients require surgery.

Although the use of Restylane as a soft tissue filler in other areas of the face is very well established and associated with a very high patient satisfaction rate, its use for the management of tear troughs or dark circles has proved to be an exciting new application. The effects of the injections last approximately 6-12 months before repeat injections are required. The treatment is undertaken as an outpatient procedure that offers immediate cosmetic results, and a very short recovery period. Restylane can also be injected as a trial without removing the option of surgery at a later stage.  It can also be used for patients who have previously undergone cosmetic eyelid surgery and have some residual hollowing of the lower eyelids.

The treatment is associated with mild discomfort. An anesthetic cream is applied to the eyelid skin 15 minutes before the injections are given. Restylane is now available containing Lidocaine, a local anesthetic agent, further reducing the discomfort of the injections. The treatment takes about 15 minutes to do. In my experience contour irregularities occur very rarely following the injections. These are managed with massage using Auriderm cream (http://www.faceandeyeshop.co.uk/product_list.cfm?id=25). If a patient is dissatisfied with the results, the Restylane can be dissolved with the use of a small injection of Hyalase (an enzyme commonly used in local anaesthetic solutions given around the eye in patients undergoing cataract surgery). To date, I have never had to resort to any such injections. Bruising and mild swelling may occur, but these usually resolve within a week. In order to reduce the risk of bruising it is advisable to discontinue the use of aspirin or any anti-inflammatory medicines e.g. Indomethacin, Ibuprofen, Diclofenac, Voltarol, for 2 weeks before treatment provided it is medically safe to do so. [Excessive bruising can stain the injected Restylane, leaving a blue discolouration in the eyelids. This occurs rarely but is the reason why it is important to avoid medications which predispose to bruising.]

This treatment has proved popular with both men and women of ages ranging from 21 to 55 years of age. [A consultation is important to ascertain a patient’s suitability for this treatment. In the hands of an experienced oculoplastic surgeon, the risks and potential complications are very small but these must be considered carefully following a discussion at a consultation before proceeding with the treatment.]

Appearance of lower lid dark circles causing a very tired appearance		Appearance 2 weeks following Tear Trough Restylane injections

 

Appearance of lower lid dark circles causing a very tired appearance		Appearance 2 weeks following Tear Trough Restylane injections

 

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