What are alternative treatments for blepharitis?

Introduction

Blepharitis is a common eye disease that affects the edge of the eyelids and the eyelash hair follicles. Symptoms include red and swollen eyelids, crusting of the eyelashes on awakening, redness of the eye, sensitivity to light, excessive tearing, frothy tears, and an itching, burning, or foreign-body sensation in the eye.

There are two forms of blepharitis: anterior and posterior. Anterior
blepharitis involves the portion of the eyelid where the eyelashes attach. It is
caused either by a bacterial infection or by part of the
same skin condition that causes dandruff (seborrheic dermatitis).

Posterior blepharitis occurs when the oil-secreting glands inside the eyelid (the meibomian glands) become inflamed and, eventually, cannot secrete properly. This leads to changes in the liquid bathing the eye (the tear film). Like anterior blepharitis, posterior blepharitis may occur as part of seborrheic dermatitis. Acne rosacea has also been associated with the condition.

Treatment of blepharitis primarily involves various methods to keep the eyelids clean and free of crusts. In some cases, antibiotic or steroid eye drops are used.

Principal Proposed Treatments

N-acetylcysteine (NAC) is a specially modified form of the dietary amino acid cysteine. When taken orally, NAC is thought to help the body make the important antioxidant enzyme glutathione. NAC is also thought to help loosen secretions, and for this reason, it has been tried as a treatment for loosening the thick crusty secretions that block the oil-secreting glands in posterior blepharitis.

In posterior blepharitis, the tear film becomes abnormal. A controlled but not blinded study evaluated the potential benefits of NAC in fifty people with chronic posterior blepharitis. All participants received standard eye care for blepharitis. In addition, about one-half the participants received NAC at a dose of 100 milligrams three times daily for eight weeks. Researchers used various methods to objectively evaluate the quality of the tear film and found that the use of NAC brought about significant improvements.

Further research, including double-blind, placebo-controlled trials, are necessary to determine whether these apparent benefits translate into meaningful improvement for people with chronic blepharitis.

Other Proposed Treatments

For various theoretical reasons, other natural treatments have been recommended
for blepharitis, including beta-carotene, citrus bioflavonoids, dandelion, evening
primrose oil, fish oil, lutein, red clover, selenium, vitamin B
complex (a mixture of vitamins B1, B2, B3,
B6, and B12, and pantothenic
acid, biotin, and folate, possibly with
inositol and choline), vitamins A, C, and E, and zinc. However, there is no
meaningful scientific evidence to indicate that these treatments are helpful.

Certain herbs have been used, traditionally in the form of eye drops, to treat blepharitis and related conditions, including barberry, bayberry, bilberry, calendula, chamomile, eyebright, goldenseal, and passionflower. However, there is no meaningful evidence to indicate that they are effective. Furthermore, using herbal preparations in the eye is risky and should not be attempted except under the supervision of a qualified health-care provider. Natural treatments used for seborrheic dermatitis or acne rosacea may also be worth considering, as these conditions are closely related to blepharitis.

Bibliography

Johnson, Gordon J., et al., eds. The Epidemiology of Eye Disease. 2d ed. New York: Oxford University Press, 2003.

National Institutes of Health, National Eye Institute. http://www.nei.nih.gov.

Sutton, Amy L., ed. Eye Care Sourcebook: Basic Consumer Health Information About Eye Care and Eye Disorders. 3d ed. Detroit: Omnigraphics, 2008.

Yalcin, E., et al. “N-acetylcysteine in Chronic Blepharitis.” Cornea 21 (2002): 164-168.