Southwest, FL | Chalazion and Blepharitis | Cataract & Refractive Institute of Florida
Dr. Croley: Hello, and welcome to case of the day. I'm Dr. Crowley, and today we're going to discuss an interesting case. This was a 19 year old young person who came in today complaining that... actually with their parents... actually complaining of that their eyes had been red and irritated and crusted and matted since they were born. And so this has been going on for 19 years. This person has had minimal different types of treatment and ointments applied, but it keeps coming back and actually, being that they're 19 years old, this is actually cosmetic because their eyes are red and irritated and crusted almost constantly.
Dr. Croley: And so when I examined this patient, they had crusting and matting and scaling around their edge of their lashes. Right where the eyelashes go into the eyelid, there was crusting and matting and the edge of their lids was all inflamed and red and slightly swollen. And the diagnosis of this is called blepharitis. Now, the common term that you may be aware of, or many people are called in the past is called granulated eyelids. And so this young person has blepharitis, and so first we'll go over the causes of what blepharitis could be.
Dr. Croley: So there's typically two causes of blepharitis. One is a seborrheic skin condition. I didn't see the evidence that this person had any seborrheic skin condition on their face. And the other is a staph infection. So what happens is staphylococcus bacteria decides to inhabit around the base of the eyelashes and can stay there in a chronic manner. If you know some studies recently, there've been studies with healthcare professionals. They took a cotton swab inside of all of these healthcare professionals and cultured those, and nearly 75% of healthcare workers have staph growing inside their noses on a chronic basis. And maybe in some studies, even up to 20% of MRSA type staph bacteria has been cultured out of people's noses who are in the healthcare profession. And we normally have staph epidermidis, which is a very typically benign form of staph, which is on our skin all the time.
Dr. Croley: So this person has had a 19 year history of this staph being around their eyelashes and lids and infecting them for all this time. So we started this person on a new treatment regiment that I think will take care of the problem. One thing about usual treatment of a blepharitis is first, we got to clean those lashes off. So you have different ways of doing that. One way you can take a Q-tip, wet it under the faucet and put a drop of Johnson's baby shampoo, not baby oil because that won't feel very good, baby shampoo on the Q-tip, and then scrub your eyelashes. You can't do this because you'd never get to the eyelash. You got to keep your eye open and scrub on the eyelashes themselves and clean the lashes off. It really helps, maybe the first thing in the morning, is to take a hot wash cloth. Put it in hot water, hold it up and let that steam and moisture loosen that up so then it's easier to remove in the morning.
Dr. Croley: So the other thing that you can do is you can actually get a product called lid scrub, our ocu-scrub, and so there are different products made, and they're little pads that have soap on the pad that also, sort of like Johnson's baby shampoo, does not irritate your eye and you can scrub your lids off with those pads. We also have a form that we sell here in the office of the same kind of pad that has an antiseptic soap also inside the solution that's what the pad to try to kill that staph bacteria, which this is what we put this young gentleman on was a scrub with antiseptic, and we have an antiseptic foam lid scrub that is just a foam that you squirt a little bit on your finger and rub that into your eyelids.
Dr. Croley: And so we also put this person on this foam to be put on at night, so just scrubbing in the morning and then foam at night, and then we also can put people on different types of antibiotic drops, a lot of times antibiotic drops with a combination of a cortisone or steroid drop to cut down on the inflammation. And in this particular case, I decided since this had been for 19 years, that we'd put this person on doxycycline, which is a tetracycline.
Dr. Croley: So a lot of teenage kids get put on tetracycline for acne, for their face, and it works. One, it's an antibiotic and two, tetracycline has an anti-inflammatory component. And so those two things help cut down on inflammation and chronic infection. So we put this person on doxycycline as well, one pill in the morning and one pill at night. And so hopefully this is going to take care of this person's problem and finally clear their lids up.
Dr. Croley: Blepharitis is a very, very common problem. We see it all the time in the office and unfortunately, in many people chronic, and it takes continuous care, and in fact, a lot of people we keep on this lid scrub hygiene forever. Just like you shampoo your hair, you're going to clean your eyelashes off. So anyway, if you have any questions about blepharitis, try to contact us through the website and until then, and we can have another discussion about a case of the day, may God bless you with great vision and healthy eyes.