Hello and welcome to Case of the Day. I’m Dr Croley and today we’re gonna 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 have been red and irritated and crusted and mattered since they were born. This has been going on for 19 years. This person has had minimal different types of treatment and ointment supplied but it keeps coming back and it’s actually, being that they’re 19 years old, this is actually cosmetic because their eyes are red and irritated and crusted almost constantly.
When I examined this patient, they had crusting and mattering and scaling around the edge of their lashes. Right where the eyelashes are going to the eyelid, there was crusting and mattering 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 called in the past, is called granulated eyelids.
This young person has blepharitis and so first we’ll go over the cause of what blepharitis could be. 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 professors. I took a cotton swab inside all of these healthcare professionals and culture those and nearly 75 percent of healthcare workers have staph growing inside their noses on a chronic basis.
And maybe even in some studies, even up to 20 percent of MRSA- staph type bacteria have been, has been cultured out of people’s noses who are in the healthcare profession. So and we normally have Staph epidermidis which is a benign form of staph, which is on our skin all the time. 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 regimen that I think will take care of the problem. One thing about usual treatment of a blepharitis is first we gotta clean those lashes off. So we have different ways of doing that. One way is you can take a Q-tip, wet it under the faucet, and put a drop of Johnson’s baby shampoo, not baby oil, ’cause that won’t feel very good. Baby shampoo on the Q-tip and then scrub your eyelashes ’cause you can’t do this ’cause you’ll never get to the eyelash. You gotta keep your eye open, and scrub on the eyelashes themselves and clean the lashes off. It really helps maybe first thing in the morning is to take a hot washcloth, put it in hot water, hold it up and let that steam in moisture to loosen that up so then it’s easier to remove them in the morning.
So the other thing that you can do is you can actually get a product called Lid Scrub or Occu Scrub and so there are different products made and they’re little pads that have a soap on the pad that’s also sort of like Johnson’s baby shampoo that does not irritate your eye and you 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 with the pad to try to kill that staph bacteria which is what we put this young gentleman on, was the scrub with antiseptic and we have an antiseptic foam lid scrub that is just a foam that you squirt on a little bit on your finger and rub that into your eyelids.
We also put this person on this foam to be put on at night. So just scrub in the morning 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 has been for 19 years that we put this person on Doxycycline, which is a tetracycline.
So a lot of teenage kids can 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. Hopefully this is gonna take care of this person’s problem and finally clear their lids up. But blepharitis is a very, very common problem. We see it all the time in the office. Unfortunately it’s got many people chronic and takes continuous care and in fact, in a lot of people, we keep on this lid scrub hygiene forever, just like you shampoo your hair, you gotta clean your eyelashes off.
So anyway, if you have any questions about blepharitis, try to contact us through the website. And until then we’ll have another discussion about the Case of the Day, may God bless you with great vision and healthy eyes.