“Doc, I Was Told I Have Granulated Eyelids”

Once in a while, a patient will tell me that a previous doctor told them they had “granulated eyelids.” What does that mean? What they are describing is a medical condition called blepharitis. Most of the time, blepharitis is caused by the staphylococcus bacteria that normally live on our skin. The bacteria are there continually, and we never get rid of them no matter how many showers you take or whatever antibacterial soap you use. To prove my point, what happens if you try to use the same towel over and over again after your shower for two weeks? The smell would be horrendous even after a few days. Why does your towel smell? Whenever you dry yourself off, some of the staff bacteria is removed from your skin onto the towel. The wet towel you hang up to dry is a great medium for the staff bacteria to grow; this is what you smell. What you are essentially doing is culturing yourself! 

When we wash our face, what do we do? We lather up our washcloth, slam our eyes shut, so we do not get soap in them, and wash our face. Consequently, the margins of our lids never get a good scrubbing. What happens with time is the staph bacteria count will increase at our lid margins. The margin of the lids is where we find our lashes which are embedded into the skin by its follicle. The follicle is a nice warm moist area, and the staff bacteria migrate down the base of the eyelashes and thrive in the follicles of the lashes; this occurs in both the upper and lower lid lashes. When I examine the patient with the microscope, I do not see the bacteria because they are too small to be seen with our normal examining microscope, but what I do see is flaking at the bottom of the lashes. The bacteria produce toxins or poisons that ooze from the follicle up the lash and form a circular hardened flake around the base of the lashes. We call them collarets. I see many patients with low-grade blepharitis, and most of them are not having any problems. As the infection continues to become worse, issues start to arise from the toxins produced. The lid margins become red and inflamed. The patient complains of red, itchy lids. The toxins will fall into the eye, causing inflammation of the conjunctiva and cornea, the clear window of the eye. When this happens, the patient complains of red eyes, blurry vision, foreign body sensation, light sensitivity, and pain. 

To treat the infection, I use a combination of steroid/antibiotic drops or ointment. The steroid is for the inflammation, and the antibiotic is to kill the staph bacteria. The drops or ointments do a fantastic job in getting the condition under control, but it will come back with time once the patient stops the medication.  The most crucial part of treating the staff blepharitis is having the patient clean and scrub the margins of both the upper and lower lids. I usually have the patient scrub both the upper and lower lids with an over-the-counter lid scrub called Ocusoft Plus every night before they go to bed. Once they work through a box of these lid scrubs, I then tell them to make sure they scrub both the upper and lower lid margins at least once a week forever; otherwise, the infection will return. This scrub is especially important in diabetic and immunocompromised patients since they tend to get more infections than a person with a healthy immune system.   

Another reason to keep the infection under control is to prevent a secondary condition called trichiasis. With chronic infection and inflammation of the lid margins, the follicle becomes altered, causing the lashes to grow in different directions. Often, the lash grows in toward the eye, causing the lash to rub the conjunctiva and cornea, causing a lot of discomfort. The treatment for this to remove the lash, but after five or six weeks, the lash grows back along with the discomfort.  Attempts to destroy the follicle can be taken, which may or may not cure the problem. My point here is to never get to his advanced condition. 

Another less common blepharitis is seborrheic blepharitis.  This patient usually has a bad problem with dandruff in the scalp area, and dandruff can present in the lid lashes as well. The treatment for this is a steroid ointment and treatment for dandruff.   

Lastly, there is a type of blepharitis usually seen in the elderly that the Demodex Folliculorum Mite causes; this parasite can live on humans. I treat this with tea tree oil. 

You will not have to worry about getting blepharitis if you pay attention to how you wash your face. Remember, the eyelid margins need exceptional scrubbing! If you are having issues and would like to schedule an appointment for this or a routine visit, please call us at 800-282-3937. 

Dr. William Corkins is an optometrist who practices at the Lakeland-Highlands, Sebring, and Winter Haven locations for Eye Specialists of Mid-Florida and is accepting new patients at this time.