Dry Eye Disease

Lid Margin Disease

Lid margin disease is a common and frequently chronic inflammation of the eyelids. Symptoms include irritation, itching, and, occasionally, a red eye. This condition frequently occurs in people who tend to have oily skin, dandruff, or dry eyes.

Bacteria normally reside on the skin, but in some people, they thrive in the skin at the base of the eyelashes. Nearby oil glands may be overactive, causing dandruff-like scales and particles to form along the lashes and eyelid margins, which can cause redness, stinging, or burning.

Lid margin disease cannot be cured, but it can be controlled with a few simple, daily hygienic measures, such as the following:

  • At least twice a day, place a warm, wet washcloth over your closed eyelids for a minute. Rewet it as it cools, two or three times. This will soften and loosen scales and debris. More importantly, it helps liquefy the oily secretions from the eyelids’ oil glands, which helps prevent the development of a chalazion, an inflamed lump in an eyelid oil gland.
  • With your finger covered with a thin, wet washcloth, cotton swab, or commercial lint-free pad, gently scrub the base of the lashes for about 15 seconds per lid.

When medications are necessary, they may include:

  • artificial tears (over-the-counter eye drops) to relieve symptoms of dry eye
  • antibiotics (oral or topical) to decrease bacteria on the eyelids
  • steroids (short-term), to decrease inflammation

Medications alone are not sufficient to control lid margin disease; the application of warmth and detailed cleansing of the lashes daily is the key.

Azasite

Azasite is a very thick, gel-like drop.  You should keep it stored on its side at your bedside table.  To use, hold above your eye and gently press on the bottom of the bottle with your index finger.  Do not try to squeeze the bottle.   It is not uncommon for the drop to burn.  The burning usually subsides after the first week, as the tear film improves and the ocular surface begins to heal.  If the burning is not tolerable, a mild steroid may be needed for the first week of usage.  A prescription for Lotemax will be called in to your pharmacy for one week if you cannot tolerate the Azasite without it.   If needed, use the Lotemax up to 2 times a day.  Do not use longer than one week.

  1. Instill one drop of Azasite into each eye at bedtime for one month
  2. Use no medication, but continue warm compresses for the second month
  3. In the third month, use Azasite again, one drop in each eye at bedtime.

Most people will have significant improvement after the third month of usage.  You should continue the warm compresses.  You may need to continue with artificial tears.