Itchy, Burning Eyes

By: Richard W. Lucius, MD, FACS, St. Cloud Eye Clinic, Phone: (320) 251-1432, www.stcloudeye.com

Are your eyes chronically irritated? “My eyes are (insert your own combination of the following) red, irritated, dry, tearing, full of discharge and my vision is blurred”. Don’t feel as if you are alone. These are some of the most common symptoms that we hear of on a daily basis. Up until recently, bacteria were thought to be the main cause of blepharitis. The answer may be the Demodex mite.

Blepharitis basically means inflammation of the eyelids. Oil is a normal component of the tear film. It is produced in oil glands that are located in the thickest part of the eyelids. These oil glands release the oil onto the eyelid margin. The eyelid margin is the flat part of the eyelid just behind the eyelashes. This oil may harden and granulate on the eyelid margin or form a collar of debris around the base of the eyelashes. This oily debris may cause any of the symptoms mentioned in the paragraph above. The bacteria that normally live on your skin like to live in this oily debris. The toxins produced by the bacteria exacerbate the symptoms. Typically, those with blepharitis will also experience blurred vision with activities such as reading, sewing, or using a computer. When people do these activities, they have a tendency to blink less frequently and their eyes dry out faster. Blepharitis is a chronic condition with no magic cure.

The most common treatments for blepharitis may include a regimen of eyelid hygiene, artificial tears, and sometimes antibiotics. The first therapy that I have patients try is to cleanse their eyelids with baby shampoo every morning. They place a small amount of baby shampoo on a wet washcloth and work up a lather. With their eyes closed, they gently scrub over their eyelashes. Next, they rinse off the baby shampoo before opening their eyes. Some people with severe cases will hold a warm, wet washcloth over their closed eyes for a few minutes before performing the lid scrub. If they still experience blurred vision or burning, I have them use artificial tears.

This condition has confounded ophthalmologists for decades. The cause of blepharitis may be as simple as a mite called Demodex. This mite typically lives in the eyelash follicle. It has also been identified in the eyebrows and scalp. Demodex has also been implicated as a causative agent in conditions such as rosacea, seborrheic dermatitis, and atopic dermatitis.

Cleansing the eyelids with baby shampoo has been shown to reduce the number of mites, but not to eradicate them. The mites have been found to be most susceptible to a plant extract called tea tree oil. This oil has been used as a traditional aboriginal medicine in Australia for wounds and infections of the skin. The oil has been shown to have antibacterial, anti-inflammatory, and acaricidal effects.

The patient with Demodex associated blepharitis can be diagnosed at the clinic. Typically, some of the patient’s eyelashes are removed and examined under a high power microscope. If the findings are positive, therapy can be initiated.

Treatment consists of several treatments of the eyelids and eyebrows with a dilute solution of tea tree oil at each visit. These treatments are repeated every week for three weeks. Do not try this at home since tea tree oil can be very irritating to the eyes and it may end up being a very unpleasant experience. The treatment continues at home with daily washing of the face, eyelids, and hair with tea tree shampoo. All of the bed linen must be washed. Women should throw out makeup and not use any new makeup for one week. Ensure that the spouse is checked. Have any pets that sleep on the bed checked or no longer allow them to sleep on the bed. For the first two weeks, patients may need to use tea tree ointment at bedtime. If the inflammation is severe antibiotic eye drops will be used for the first couple of weeks. Most patients will notice a dramatic improvement in their symptoms within the first two to three weeks.

Demodex has been implicated as a cause of blepharitis in the recent literature. The above mentioned treatment has been found to be the most effective. Hopefully, it will give some lasting relief to those suffering from chronic itching and burning eyes.