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A Guide for Patients

Dry eyes and blepharitis

Dry eyes and blepharitis are both common conditions, which often occur together.
Dry eye, also known as keratoconjunctivitis sicca, occurs when your eyes don't produce enough tears, or the tears they do produce aren't of the right quality. 

Blepharitis occurs due to inflammation of the eyelids, which is often associated with the growth of bacteria. Eyelids become red, and may have a crusty or sticky discharge, more noticeable in the mornings.

Although uncomfortable, these conditions are not usually serious and there are things you can do to help. 

Management of dry eyes

It is not uncommon for glaucoma patients to suffer with dry eyes. Symptoms include the feeling of dry, gritty eyes, increased redness, and increased watering. Some patients feel like there is something in their eyes and may experience episodes of blurring. Symptoms usually improve if the eyes are closed and if a preservative-free dry eye drop is applied. Unfortunately, dry eyes can be worsened by the use of eye drops to treat glaucoma.
Some sensible advice to reduce the symptoms of dry eyes is set out below:

  • Ensure you are well hydrated by increasing your intake of water and reducing your intake of drinks containing caffeine

  • Reduce your heating, air conditioning and car fan settings

  • Use wrap-around glasses if outside on a windy day, or when driving

  • Stop or reduce contact lens wear

  • Consider flaxseed oil or omega 3 supplement tablets

  • Use a preservative free dry eye drop containing sodium hyaluronate or carmellose, 4-6 times per day (available over the counter)

  • Use a preservative free gel for dry eyes containing carbomer or white soft paraffin, last thing at night before sleeping (available over the counter)

  • Ask your ophthalmologist about switching to a preservative free glaucoma drop

  • Ask your ophthalmologist to consider changing drops that are more likely to cause dry, uncomfortable eyes, such as Lumigan (bimatoprost) and Alphagan (brimonidine), to an alternative

  • If using glaucoma drops, close your eyes after applying the drops and ensure you wipe any excess off your eyelids using a clean damp tissue. This will reduce eyelid irritation

In severe cases, asking your ophthalmologist for a short course of steroid and antibiotic eye drops may help.

Management of blepharitis

Blepharitis is a condition causing inflammation of the eyelid margins. Though not infectious, it is associated with the growth of bacteria, and symptoms may be worsened by the use of glaucoma eye drops. Blepharitis can worsen symptoms of dry eyes. Patients with blepharitis may notice red, crusty or sticky eyelids on waking. Blepharitis is usually a long-standing condition and requires long term changes to manage.
Sensible advice includes:

  • Use a heated eye bag/eye mask (available online and from some opticians and pharmacies) 1-2 times a day before cleaning your eyelids

  • Clean your eyelids every morning and evening with your eyes closed, using a clean flannel and warm tap water (this does not need to be boiled). Massage the lids towards the lid margins (the top eyelid down and the bottom eyelid up)

  • Some people advocate using a gentle cleaner such as baby shampoo, or a pre-made wipe containing a cleaning agent, but the evidence is limited and it is probably better to use warm water alone

  • ​If using glaucoma drops, close your eyes after applying the drops and ensure you wipe any excess off your eyelids using a clean damp tissue. This will reduce eyelid irritation

  • Ask your ophthalmologist whether switching to a preservative free glaucoma drop would help

  • Ask your ophthalmologist to consider changing drops that are more likely to cause dry, uncomfortable eyes, such as Lumigan (bimatoprost) and Alphagan (brimonidine), to an alternative

  • Ask your ophthalmologist whether you would benefit from a course of oral antibiotics such as doxycycline or azithromycin

  • In severe cases, asking your ophthalmologist for a short course of steroid and antibiotic eye drops may help.

For a video explaining lid cleaning techniques in more detail please see below:

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