A patented in-office procedure plus at-home care gives patients relief from this common condition
Blepharitis is one of the most common eye conditions, and yet it is one of the most under-diagnosed. Why? First, like dry eye or allergies, blepharitis symptoms can be mild or easily mistaken for other issues. So patients may dismiss symptoms, not knowing there’s a name or treatment for what they’re experiencing. Second, blepharitis—by definition, inflammation of the eyelids—often isn’t diagnosed until it is severe, which involves debris or discharge on the lashes.
The fact is that blepharitis begins years or decades prior. Recent research has shown significant bacteria to be present within the follicles of lashes and in a biofilm surrounding the base. A 2016 article in Clinical Ophthalmology proposed that dry eye is simply the late form of chronic blepharitis. The authors suggest the use of a new term to describe this one chronic disease, “dry eye blepharitis syndrome (DEBS).” While this isn’t the only path to development of dry eye, many believe that dry eye starts with the overgrowth of bacteria on the lid that needs to be removed by a combination of treatments. Here’s what eye care professionals (ECPs) need to look for, and the latest treatment options.
Early diagnosis is key
Like any disease, early diagnosis is key to management success. To detect blepharitis earlier, ECPs should be on the lookout for what’s termed a “volcano sign,” where the lash seems to be pulling out debris as it grows out of the follicle. Blepharitis is also present as meibomian gland dysfunction (MGD), so it’s necessary to express the meibomian glands of every patient to see if the meibum is thickened, paste-like, or non-expressible. Some have even described this as a meibofilm. MGD treatment should also include thermal pulsation options and hydrating compresses such as the Bruder Mask.
A range of treatment options, including one in-office procedure
We have a plethora of treatment options available, ranging from lid scrubs to blepharoexfoliation. Both need to be included in the proper treatment of blepharitis. Think of the dental model: a dental hygienist performs in-office teeth cleaning, but patients still brush and floss at home. Likewise, encourage your patients to see their ECP or “eyegienist” for in-office mechanical cleaning and to use lid scrubs and hot compresses at home.
Encourage your patients to see their ECP or “eyegienist” for in-office mechanical cleaning and to use lid scrubs and hot compresses at home.
There is currently only one in-office treatment option available directed at blepharitis and that is BlephEx ™. BlephEx is a patented hand piece used by a doctor or technician to quickly and painlessly perform blepharoexfoliation of the eyelids including the eyelashes and lid margins. To date, there is no third-party reimbursement or CPT code, noted John A. Hovanesian, M.D., FACS, in Primary Care Optometry News. “We charge about $250 for treatment to both eyes, which needs to be repeated once to twice a year, depending on disease severity.”
It works like this: a foam surfactant or soap-based solution is applied to the disposable tip, and the device spins at 2,500 RPM. There is a reverse button that further cleans the tissues and the reverse direction seems to enhance the cleaning effect. Patients will comment on how good it feels as you remove debris and biofilm that has been there for years or even decades.
Safe, long-term at-home treatments
There are numerous home treatment options ranging from hypochlorous acid (HOCl) to surfactant based lid scrubs and even tea tree oil-based eyelid cleaners (like Lid and Lash with TeaTree, Oust or Cliradex for demodex blepharitis). HOCl lid cleansers include products such as Zenoptiq, Avenova, SteriLid anti-microbial or Hypochlor. What makes this product appealing is that HOCl is an all-natural antimicrobial agent. Pure HOCl is produced by neutrophils as an immune response during an infection. Highly reactive molecules such as HOCl are generated as white blood cells respond to pathogens. I tend to use these in more advanced cases but they are safe to use long-term and have great antimicrobial properties.
Surfactant cleaners have the added benefit of removing oils—essential in cases of blepharitis—in addition to being highly antibacterial.
Surfactant cleaners like Lid Scrub Plus, Lid and Lash, or SteriLid are ideal for long-term use. The surfactant or soap component has the added benefit of removing oils in addition to being highly antibacterial. In cases of blepharitis removing these oils and the biofilm is essential. Show this short video in your waiting room or exam room to demonstrate proper hygiene and cleansing technique: “Lid Hygiene: Eyelid Scrub (Pre-Moistened Pad Method)”
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Blepharitis is common and needs to be diagnosed early and treated the moment the first signs of disease are present. Be proactive about patient education and communicating the importance of regular eye exams.