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Paediatric blepharitis

Blepharitis is a common condition that causes inflammation of the eyelids. It is a common eye disorder throughout the world and affects people of all ages.

How you see the world

If you have blepharitis your eyesight is rarely affected, but the condition could be uncomfortable and persistent and prevent you from doing normal daily activities.

Symptoms you might have can include

  • Red, greasy and sore eyelids.
  • Thickened and swollen eyelids.
  • Tiny flakes or crusts that look like dandruff at the bottom of the eyelashes a feeling that there is something in your eye.
  • Itchy, dry or burning eyes.
  • Sensitivity to light.
  • Blurred vision.
  • Eyelashes growing inwards.
  • Occasional loss of eyelashes and scarring of the eyelids.

How the world sees you

If you have blepharitis you might have red, puffy or crusty eyelids and sometimes red eyes.

Why did I get it?

The exact cause of blepharitis is not known, but people who have skin conditions like eczema seem to get itmore.

What causes it?

Your eyelids contain tiny glands that make oil which mixes with tears to keep your eyes moist and comfortable. If these glands become blocked, it prevents them from keeping your eyes properly lubricated.This can make your eyes feel sore or gritty.

There are two types of blepharitis: Anterior blepharitis affects the front of your eyelid, where your eyelashes are attached. Anterior blepharitis is caused by a sensitivity to a substance produced by bacteria(staphylococcus) normally found on the skin. Some people are sensitive to this substance which leads to inflammation.

Posterior blepharitis affects your inner eyelid (the moist part that makes contact with your eye) and is caused by problems with the oil glands in this part of your eyelid.

How can the doctor tell?

The appearance of inflamed eyelid edges and flakes on the lashes is typical of blepharitis. An examination of the eyelids and eyelashes is usually enough to diagnose blepharitis. A slit lamp microscope is used for a more detailed examination.

Getting it sorted

If you have blepharitis, it can come back at any time, although the severity can vary.

Good eye care is essential to stop the condition occurring again, even when the symptoms are not there.The steps below, called lid hygiene, ease the symptoms:

  • Warm compress: Soak cotton wool or a clean flannel in warm (but not hot enough to burn) tap waterand gently press onto your closed eyelids for two to three minutes at a time.
  • Massage your eyelids by gently rolling your finger over them in a circular motion. This helps to push the oil out from the tiny eyelid glands.
  • Use a cotton bud slightly moistened in tap water to gently clean the edge of your lower lid.
  • Pull the top lid away from your eyeball while looking in a mirror, and clean the edge gently. Repeat this routine once or twice every day to prevent further flare-ups.

Facts

  • Blepharitis does not usually affect vision or damage the eye in most people.
  • Blepharitis is treated by careful cleaning of the eyelids

Occasionally antibiotics by mouth or steroid eye drops will be prescribed to treat your blepharitis. In some cases, your doctor will prescribe an antibiotic ointment or eye drops. If you are asked to use these, follow the steps below:

  1. Lie down, or lean the head back, and look up.
  2. Use a clean finger to gently pull down your lower eyelid to create a pocket.
  3. If you are using eye drops, gently squeeze them into the pocket you have created, not directly onto your eye.
  4. If you are using ointment, apply a small strip into the pocket.
  5. Blink to spread the medication over your eye.

When the going gets tough: lid cysts

Sometimes a chalazion (lid cyst) can grow, which is an enlargement of an oil gland and has similar symptoms to a stye. After a few days, the symptoms disappear, leaving a round, painless swelling sometimes with discolouration underneath the eyelid. Most disappear within a few months without treatment. To help the cyst to go, warm compresses can be used (see above).

In some people, especially children, blepharitis can cause serious inflammation of the eyes which can affect the health of the cornea (window of the eye). This is called blepharokeratoconjunctivitis (BKC) and needs medication such as long term low dose antibiotics by mouth, or stronger drops including steroids and ciclosporin to protect the vision.

A&E for children is located in the Richard Desmond Children’s Eye Centre

Opening hours: 9am - 4pm, Monday to Friday.

Outside of these hours, please attend the adult A&E department at Moorfields City Road (around the corner).

video transcript
To clean the eyelids the first step is to do a warm compress which softens the debris on the eyelids making it easy to clean off.
Place a clean face cloth under a hot tap, nice and hot but not hot enough to burn or be uncomfortable. Wring it out and hold the hot compress on top of the closed eyes for one or two minutes.
If the cloth becomes cool, warm under the tap again, wring and replace it on the closed lids.
Next we perform the cleaning for older children we use a moistened cotton pad. This can be moistened in warm tap water or by using a weak solution of baby shampoo or bicarbonate of soda.
Squeeze out any excess moisture.
First you clean the back edge of the eyelid. Pull down the lower lid and run the bud firmly but gently along the thin line of skin behind the lashes four or five times.
 Do the same for the top lid putting it up and away from the eye. Then we clean the lashes. For the top lid, close the eyes firmly and scrub vigorously at the base of the lashes doing a small part of the lid at a time and moving gradually along the width of the lid to do all the lashes.
In the same movement to use for brushing your teeth. Then open the eye, look up and repeat with the bottom lid lashes, again moving gradually along the lid to ensure all the lashes are clean.
Ideally older children should be taught to do this themselves.
For younger children we start again with a warm compress.  Then use a face cloth to clean the lid edges moistened in warm tap water or with a weak solution of baby shampoo or bicarbonate of soda.
After moistening wring out the cloth wrapped the cloth tightly around the index finger so it covers the length of the finger holding the rest of the cloth in the hand.
With the child's eyes gently closed lay the finger with the length of the cloth along the lashes apply gentle pressure towards the eye and wipe up in a sweeping motion two to three times to clean the upper lid.
The gentle pressure towards the eyes will allow the eyelids to turn out a little so that the back edge of the eyelids are cleaned. Then wipe down two or three times in the same way to clean the lower lid.
To clean the base of the lashes; with your child's eyes tightly closed use the length of the the finger covered by the cloth to rub quite vigorously along where the lashes come out at the skin moving along the eyelids so that all areas are cleaned.

Richard Desmond Children's Eye Centre

The Richard Desmond Children's Eye Centre is our dedicated children's hospital. It is based on the same campus as the main hospital in London's City Road, but has a separate entrance in Peerless Street.

 

Richard Desmond Children's Eye Centre, Moorfields Eye Hospital.

3 Peerless Street

London

EC1V 9EZ

 

Call 0207 253 3411

Author: Paediatric information group

Review date: November 2021