Treatment for Blepharitis, Chalazia, Styes and “Wet” Dry Eye

All of these conditions can be uncomfortable, unsightly and sometimes distressing. There are many differing options on how to deal with them, and advice should be sought from an eye care professional. However, we believe that the following simple self help remedy can go a long way to relieving the symptoms, although there is no permanent cure.

We will start with “wet” dry eye which can be diagnosed with a few simple tests at an eye exam. The obvious question is always “How can I have too many tears and still have a dry eye problem?” Simple, the tears are on your cheeks – not in your eyes. The reality is that in this case, the viscosity (or oiliness) of the tears is too low, meaning that they do no remain on your eyes as well as they should and more crucially, they evaporate very quickly exposing the cornea, causing a reflex production of more tears. Of course, this further dilutes the tears causing them to run off the eye leading to more exposure of the cornea. This leads to further irritation, creating a vicious cycle.

Usually, dry eye problems arise not from insufficient tear quantity, but by poor tear quality; this is caused by not enough oil (called meibum) being produced. Meibum is produced by small pore like glands in the eyelid margins, totalling about fifty in each eye. The problem is that they can get blocked. Come and see us if you want the full reasons for this explained.

There are many and varied theories about how to get these little meibomium glands working, but here is ours, and what we believe to be the best method.

Applying heat to the eye

This first stage applies to blepharitis, chalazia and styes as well as “wet” dry eye.

Fill a basin with hand hot water (approximately 46 degrees Celsius to 48 degrees Celsius). Water out the tap is ok.

  1. Place a clean face cloth in the water and wring it out.
  2. Place it on the eye (we recommend doing one eye at a time) for ten seconds – any longer and the temperature of the cloth drops too much to be effective.
  3. Repeat half a dozen times as quickly as possible, and then treat the second eye.
  4. Do this twice a day for seven days. Thereafter, once a week or fortnight should be sufficient to keep symptoms under control.

Most people will notice a significant improvement after three days. If this all sounds like too much trouble (it isn’t), then we can supply eye bags which are a simple alternative. These are available in our practices. For the control of blepharitis and more severe dry eye problems, after the heat application some authorities advocate the use of dilute baby shampoo applied with cotton wool buds or balls. We are not fans of this as this can further disrupt a compromised tear film. We prefer a very dilute solution of cooled boiled water and bicarbonate of soda and salt (1/4 teaspoon of each in 1/2 cup is about right). Lid wipes are an inexpensive and soothing alternative. More severe or non-resolving eye problems are best dealt with by an eye care professional or GP. This may involve oral or topical antibiotics or even a short course of steroid eye drops.

Digital Screens and the 20/20/20 rule

It is known that when you look at a computer screen, your blink rate halves. This means that your tear evaporation rate increases, causing changes in your tear film chemistry which leads in the short term to discomfort due to a drop in your tear ph, in the medium term to physiological changes eg meibomian gland blockage and over production in mucus, both implicated in blepharitis and permanent anatomical changes in conjunctival and eyelid structures in the long term. The human eye was not designed to look at screens at a fixed focal length for long periods of time. If you were to hold a tin of beans and lift it up and down rotate it, move it from side to side, you could keep it up for a long time. If you were to hold it steadily in front, your muscles would struggle after a minute or two. This is what happens when you look at a computer screen without relaxing the eyes for extended periods. This is where the 20/20/20 rule comes in in. Given that most of the above issues start to become a problem after thirty minutes, it makes sense to take a break every twenty minutes. This is not a tea break, simply look at something twenty feet away and blink twenty times for yes, twenty seconds. This is very simple and very effective. Research also shows that people who follow this simple process are more productive and comfortable.