Blepharitis Pro Tips

October 29, 2015 9:22 PM

I have blepharitis, a condition that makes my eyelids very prone to chalazions (warning: gross). As far as I can tell, this isn't something that can be cured per se, but there are things that can be done to lessen the symptoms. What works for you, fellow blepharitis sufferers?

I've been dealing with this for about 3-4 years, though it took me a while to get the actual blepharitis diagnosis (see my previous stye question). Since this started happening, I've had to have so many chalazions surgically removed that I've lost count (it's more than 10, perhaps 15+?). I believe my blepharitis is related to my rosacea, which I also asked a previous question about and subsequently got a diagnosis and treatment for. Right now I use Metronidazole gel (topical prescription) on my face and the rosacea is mostly under control. Sadly, that product isn't safe for eyelids. My current routine is:

- cleanse eyelids twice a day with Ocusoft Lid Scrub Foaming Eye Cleanser, which I find more convenient than the Ocusoft pads
- warm compress 1-2 times per day (I try for 2 times, but if it's a hot day, it's just too hot to deal with it at night and then I just do it in the morning). I use this "sinus pillow" that you're not supposed to heat and then put on your eyes, but I do. I heat mine about 15 seconds in the microwave, sometimes up to 30 seconds if it starts off really cold in the winter or something.
- try to rub my eyes a lot to encourage draining of anything that might be brewing or is already there... though this is starting to make me paranoid about wrinkles! (I'm 35)
- on the very rare occasions I wear eye makeup (0-1 time a year), I first wash it off with Cetaphil Daily Facial Cleanser and then proceed with my Ocusoft routine
- I kind of mildly try to eat EFAs at least once or twice a week. One ophthalmologist I had recommended taking fish oil supplements, but I really hate supplements and the brand she suggested was insanely expensive, so I never got them.

This is all the stuff every doctor I've ever seen about this issue has told me to do (except for how I'm half-assing the Omega 3s), but I still have chalazions and/or styes at least 50-80% of the time. They're so unattractive and uncomfortable. So: what other stuff has helped your blepharitis? Any other products or habits I should try? I want to do everything I can that's reasonable and won't completely overtake my life. I'm kind of hoping there's some magical solution that my doctors thus far have kept secret from me. Clue me in, internet! Thanks in advance.

posted by pupstocks to Health & Fitness (19 answers total)

My opthalmologist told me to wash my eyes with baby shampoo, and to eat (any brand of) fish oil supplements. You might be able to get fish oils in liquid form and add them to your smoothies or salad oils so they don't feel like supplements. You could, of course, just eat more cold water fish, like mackerel, salmon, and sardines, a few times a week.
posted by Atrahasis at 9:37 PM on October 29, 2015

I don't want to sidetrack, but is your dermatologist aware of recent evidence that rosacea is related to mites? I've used tea tree oil (which kills mites and fungus) on my rosacea, and it cleared the patches up in weeks. I know eyelids have their own special brand of mites, and I really don't want to get to woo with this post, but it might be worth a try. FWIW, I've also used the tea tree oil on my eyelids and eyebrows since mites are also connected to hair loss.
posted by ereshkigal45 at 9:44 PM on October 29, 2015 [7 favorites]

OK, so maybe my post is not so woo after all. Googling blepharitis and demodex led to me a ton of links, but this one specifically discusses the use of tea tree oil in managing demodex.
posted by ereshkigal45 at 9:50 PM on October 29, 2015

try to rub my eyes a lot to encourage draining of anything that might be brewing or is already there... though this is starting to make me paranoid about wrinkles! (I'm 35)

Are your hands always scrupulously could-cook-for-another-person clean when you rub your eyes? I used to get styes all the time when I wore contacts, from getting whatever was on my dirty hands into my eyes.
posted by Juliet Banana at 10:07 PM on October 29, 2015

I take doxycycline for my rosacea and it's been amazing. Works much better than the topicals. It also helps stave off the bumps I get on my eyelids. They're small, but a pain all the same.
posted by crankyrogalsky at 10:52 PM on October 29, 2015

My husband suffered from this for quite a while. It occasionally kicks up when his allergies get worse. Our ophthalmologist had him wash his eyelids/lashes with (of all things) Head and Shoulders dandruff shampoo and a washcloth. Tegrin is another shampoo that was suggested. He did this twice a day. Additionally, he was given antibiotic drops if anything got particularly...gooey looking.

I should note that it was important that pillowcases and face towels were replaced daily. We just opted for putting towels down and switching those out (pillowcases are expensive!). Head to the dollar store; pick up a stack of white washcloths and hand towels that will fit on your pillow (then bleach the hell out of everything once a week!). If I recall correctly, I think we may have even done extra washcloths for wet, warm compresses. As mentioned upthread, keeping everything as meticulously clean as possible is a huge part of the battle of the eye ickies. I'm sure you know this already, but toss any old eye makeup (especially mascara) that's been festering.

Hope you can get this under control. Feel better!
posted by dancinglamb at 12:10 AM on October 30, 2015

I take doxycycline for my rosacea and it's been amazing.

I do the same and it has more or less cured my eyelid problems.
posted by a lungful of dragon at 1:50 AM on October 30, 2015

My optometrist suggested putting 1/2 cup of uncooked rice apiece into two socks, heating them gently in a microwave, and compressing them against closed eyes for 5 minutes. I heat them at 30% power for 2 minutes so that they're warm but not hot. After compresses, massage closed eyes gently. There should be some tears.

The point is to get the naturally occurring oil secretions going again.

Note that I have mild blepharitis. This treatment, plus 2 tsp of flax oil a day and staying away from too much smartphone use, works pretty well for me. Staring at screens, especially little ones, aggravates the dry eye.

If infections, etc. are an issue, change the rice and wash the socks frequently. I don't have this issue so I don't have any specific suggestions there.
posted by Sheydem-tants at 3:58 AM on October 30, 2015 [1 favorite]

For my relatively mild but persistent blepharitis, I've been told by a couple of different GPs to moisturise my eyelids when I do the rest of my face, using a plain unscented moisturiser like E45 lotion, and to use Blephasol on cotton pads to clean them. Not sure what the nearest American equivalents would be, but I've found both of them really helpful when I manage to apply them consistently. (Also I was told that I shouldn't rub them (or touch them in fact) at all when I wasn't applying the moisturiser or Blephasol - which is really freaking difficult obviously, but they do seem to get worse when I rub them, so I'm trying to follow that one.)

Anyway good luck OP, hope you find something that works.
posted by Otto the Magnificent at 4:32 AM on October 30, 2015

Yeah, I try not to touch my eyes, and I clean my hands with sanitizer or with soap and water every time I am going to touch my eyes (put in contacts, take out contacts, put on moisturizers, anything). I don't know why you'd be rubbing your eyes? Everything I've been told or read counter-indicates touching your eyes if you don't have to.
posted by Medieval Maven at 6:51 AM on October 30, 2015

I was prescribed oral doxycycline as part of dealing with a chalazion and noticed that it cleared up my rosacea too, so my doc kept prescribing it for that (in combo with an ivermectin cream). Had to wangle the script to make sure I was getting the generic so my insurance would cover it, but it works great. The metronidazole cream did not work for me.
posted by Wretch729 at 7:17 AM on October 30, 2015

I also have had chronic blepharitis for more than 10 years, sometimes so bad that it makes my vision blurry and I have trouble reading computer screens or driving.

Baby shampoo - I use it on the whole eye area, it only really helps when I remember to do it a couple of times a day, but when I do it's really really helpful. When I finally doubled-down and started using it every single time I showered, I noticed a month later that I my eyes were better than they had been in years.

Hot compresses - also work but as you note they are a pain in the ass and when it's warm it's even worse

But I mostly wanted to write to ask you to double-check about rubbing your eyes. My eye doctors have told me numerous times to try to avoid touching my eyes as much as possible, and specifically warned me about rubbing.
posted by skewed at 7:54 AM on October 30, 2015

Response by poster: Thanks everyone for your ideas!!

My first ophthalmologist that I saw about this problem is the one who told me to rub my eyes. He said it would help to encourage whatever gross stuff was getting clogged in there to come out. However, I do think the advice is kind of suspect, and since many of you have gotten conflicting advice, maybe I'll lay off that for a while. (I am an obsessive hand-washer and keep everything clean.)

That dr also gave me some eye drops (Durezol, I think? Something like that) to use when I felt a chalazion coming on. I don't know for sure whether they helped or not, but I think maybe they did. But then I moved to a new state and the ophth I saw here was meh on eyedrops. I've changed insurance, though, so I'll be seeing a new doctor the next time I have to have one surgically removed, so I might specifically ask for something like that again and see if they'll give it to me. (I should clarify that I get chalazions very frequently, but they're only bad/persistent enough to have to be cut out sometimes -- as I said, 10-15ish in the last 3 years.)

The first dermatologist I saw about the rosacea prescribed doxycycline (after trying another low-dose antibiotic -- the name escapes me now -- that gave me some bad side effects), but unfortunately it didn't do anything for me! The metrogel gave me much better results. Although the rosacea isn't totally gone, it's much better than it was.

Keep them coming, brethren/sistren in eyelid issues!
posted by pupstocks at 8:27 AM on October 30, 2015

Another sufferer here. I do everything you do (to little avail, like you), but I also use antihistamine eye drops since the prevailing theory is that allergies and the concomitant frequent eye watering is the cause of mine. (I don't get styes, but I do have the annoying pinguicula as a result of the blepharitis.)

The microwavable eye pillow also feels really, really good first thing in the morning. (When I'm being good to myself, I combine its use with a 5- or 10-minute round of guided meditation and basically feel like a self-care ninja.)
posted by mudpuppie at 8:54 AM on October 30, 2015

(Plus, an antihistamine at night, in addition to the drops.)
posted by mudpuppie at 8:55 AM on October 30, 2015

I've had to have so many chalazions surgically removed that I've lost count

Oh my word I feel for you. I can't fathom. I get maybe one per year and they are very nearly the most painful things I've ever experienced.

I rely on compresses, but here's a thought: have you ever been through an allergy test? I had one when I was a kid, but I've moved a lot in the 25 years since then. I recently bought a house and "settled down" as they say, so I finally got the full allergy test again for my locally prevalent plant, mold, insect, animal antigens. Surprise: I'm allergic to everything. I started low dose allergen (LDA) therapy (i.e. allergy shots) earlier this year and have noticed a remarkable decrease already in the severity of my allergic responses, especially in terms of my eyes. The benefit being that I rub my eyes less, and have had fewer instances so far of oh-god-is-this-a-stye-coming-on. Something to consider.

My first ophthalmologist that I saw about this problem is the one who told me to rub my eyes. He said it would help to encourage whatever gross stuff was getting clogged in there to come out.

I've always received the same advice, and I don't consider it suspect. Warm compress followed by pressure/rubbing in the direction of gland openings has some clinical support behind it. I've even had a look at the exudate from my glands before and after compress/pressure, and anecdotally the post-compress liquid is usually full of bacteria, oil and debris. The key is to simply make sure your hands and fingertips are quite clean before you go through the process.

I've also used the tea tree oil on my eyelids and eyebrows

OMG be very careful if you follow this advice. Tea tree oil, especially undiluted, can be a quite strong ocular irritant.
posted by late afternoon dreaming hotel at 10:25 AM on October 30, 2015

I've had miraculous results for my rosacea with an ivermectin-containing cream, Soolantra, which is vastly more effective for me than Metrogel (previously my best treatment), with no side effects at all for my sensitive skin. A web search for ivermectin plus blepharitis indicates that this drug is also used to treat that. I saw some reports on using oral ivermectin for blepharitis; I don't know if there are ivermectin eyedrops as well. Definitely something to ask your doctor about.
posted by artistic verisimilitude at 11:13 AM on October 30, 2015

I used to get those all the time. My step father is an ophthalmologist and he suggested anytime I felt one coming on, or I had swollen eyelids from allergies or whatever, to put anti-dandruff shampoo on my eyelids, leave it for 3 minutes, then wash it off, kind of like Dancinglamb suggests. Sounds bizarre, but it works immediately to take swelling down and make it stop hurting/itching. He also gave me some antibiotic eye ointment, which helped as well.
posted by ananci at 11:35 AM on October 30, 2015 [3 favorites]

Follow on comment:

I recently had a really bad attack and nothing is helping except, no kidding, applying water and 1-2 drops of tea tree oil to a cotton pad and gently patting my eyelids. Further research of Tea Tree oil and blepharitis gets you here: Cliradex. So that's another resource, and I found this article helpful in this time of GOOD GOD MAKE IT STOP.
posted by Medieval Maven at 7:54 AM on November 24, 2015