Blepharitis is a common, chronic eyelid condition that causes red, irritated eyelid margins with flaky material stuck to the eyelashes (Click here for animation, 4a). 
Have you ever seen kids with dandruff on their eyelashes? That is Blepharitis. (See the picture on the right. The yellow flaky stuff on the eyelashes should not be there). It occurs when the tear-secreting glands in the eyelid cannot discharge their materials onto the eyeball surface correctly. The secretions get clogged up and collect on the eyelashes, causing chronic red, irritated eyes and, when severe, low-grade chronic infections of the eyelid. The toxins from the bacteria from these low-grade infections can irritate the corneal surface. This is seen by the doctor as small punctate staining along the cornea/eyelid interface.
Styes develop when the glands in the eyelid get completely blocked off, causing the secretions to build up inside the individual gland, forming a lump. Styes are really just a pimple in the eyelid. If the stye gets really red, 
it may be infected and require antibiotic pills for a while, but the most important treatment is still doing WC/LS (see below) enough times per day to relieve the blockage and then once a day for life. The pictures at right represent styes and you will probably recognize how often you have seen them.
Acne Rosacea is a chronic condition of unknown cause affecting the eyelids and skin around the eyelid. A ruddy complexion of the cheeks and nose is the hallmark of this condition. Acne rosacea is usually more common in fair complexioned peoples. The main treatment for all three conditions is the same and is called warm compresses and lid scrubs (WC/LS), described below. These three conditions, blepharitis, styes and acne rosacea can usually be controlled with the simple cleaning techniques described under warm compresses and lid scrubs, but these techniques need to be done for life.
Warm compresses (WC): This is performed by getting a washcloth very warm under tap water. (Don’t burn yourself). Place the warm washcloth on your eyelids with your eyelids closed. This is the compress part. Wait until the cloth gets cool, about 15 seconds, and then repeat the compress at least 3-4 more times, re-warming the washcloth each time. The idea is to soften up any dandruff and debris stuck to the eyelashes so that the next thing we do, the lid scrubs, can wash this stuff off. Warm compresses also warm the eyelids and open up the glands in the eyelid, allowing them to drain normally. The openings of these eyelid glands are right where the eyelashes attach to the eyelid.
Lid Scrubs (LS): After you have done the compresses, get the washcloth soapy with Dove soap or Johnson’s baby shampoo. Use baby shampoo if you tend to get soap in your eye when you wash them. Wash the eyelids with the soapy wash cloth side to side. Do not go up or down since this will tend to get soap in your eyes and burn them. Rinse off the soap with the washcloth.
Initially, perform WC/LS at least twice a day, preferably three times a day for three weeks or until the swelling/ redness have decreased significantly. Then you can decrease it to once a day. Keep in mind that WC/LS will need to be done once a day for the rest of your life. Most patients stop doing the WC/LS once their eyes feel better. Then their symptoms return, they come see me and we start all over again with the three-times-a-day WC/LS regimen.
DRY EYE:Dry eye is a very common chronic disorder, more common in adults. Patients with dry eyes often feel like they have sand in their eyes, develop a burning sensation or have chronic redness of the eyes, typically worse as the day progresses. Most of the time, patients notice that a good night’s sleep will relieve a lot of the symptoms of dry eyes, and this is an important diagnostic consideration. Occasionally, some patients complain of watery eyes and are surprised to learn that the underlying problem may be dry eyes. What is happening here is that when the eyes dry out and get irritated, reflex tears are secreted in an attempt to relieve the burning or irritation. Unfortunately, the reflex tears are not the same quality of tears as the baseline tears and frequently the reflex tears make the dry eye condition worse since they wash away the good baseline tears.
What causes Dry Eye?
What causes dry eyes is usually a lack of tear production. The tears are a complex mixture of at least three layers made from an assortment of glands in and around the eyelids. The tears are secreted onto the eyeball, wash over and soothe the corneal surface and drain out of the eye's surface into the nose through a canal in each eyelid. (Click here for animation,9a and 9b). Dry eyes become symptomatic when the cornea dries out before the next blink occurs. Decreased blinking from reading, generalized decreased tear production or secondary medications such as anti-histamines or diuretics gives rise to the discomfort felt in dry eyes. Occasionally, chronic conditions such as Blepharitis or auto-immune disorders (Sjogren’s syndrome) can also give rise to dry eyes but by far, the most common reason is just a lack of tear production by the glands in and around the eyelids due to getting older. I find that dry eye is much more common in Caucasians than in other races, but I have not seen this emphasized in the research literature.
What treatments are available?
The initial treatment consists of taking omega 3 polyunsaturated supplements such as fish oil or flax seed oil and replacement tear application in the form of over-the-counter artificial tear supplements such as hypo tears, refresh or genteal. (Do not use Visine as the vaso-constrictor effect of Visine does nothing for your dry eyes and may cause a rebound worsening of the redness). Since dry eyes is a chronic condition and will be with you the rest of your life, taking drops all of the time gets old quickly. This brings up the next treatment option, which is punctal plugs.
(Click here for animation, 9c) Punctal plugs are little plugs placed into the drainage canal of each eyelid and stops the tears from draining away. They have been around since at least 1990. I prefer to initially put in a total of four temporary plugs that dissolve away in 24-36 hours. This will give you an idea if you like their effect. After I place the temporary punctal plugs in the eyelid, most patients forget about their dry eye symptoms for 24-36 hours. After the temporary plugs dissolve, the symptoms recur and the patients realize that the punctal plugs did indeed help significantly reduce their dry eye symptoms. I will then see you back in two weeks for the permanent plugs. I usually only place permanent plugs in the two lower canals in order to avoid too many tears being preserved and causing tears to spill onto your cheeks (called epiphoria). Epiphoria occurs less than two percent of the time. Even with permanent plugs only in the two lower puncta, conditions can occur where the upper canals get plugged up from another irritant and we can still get epiphoria. Typically an antibiotic/steroid combination drop will clear this up. Even rarer still, the plug can travel down the canal and require further treatment to stop the epiphoria, even requiring surgery to do so. Fortunately, this rarely happens.
There are two main types of permanent plugs, the acrylic smart plug and the silicon Oasys. The smart plug goes inside the canal and is not felt above the eyelid. It stays there for life. I have had a few patients that have developed chronic, low grade irritations associated with the smart plug in the last 6 months or so. Due to the difficulty in removing the smart plug should this occur, I am leaning away from fitting the smart plug. Older silicon plugs that went completely into the canal tended to migrate down the canal where it would block off both drainage canals, the upper and lower, resulting in epiphoria. This happened too often and they are not used anymore. Patient complaints from these older types of plugs can still be read on different blog sites. Another type of silicon plug, the Oasys, has a part that stays above the eyelid, preventing it from going into the canal. However, the Oasys can fall out or be rubbed out by you, so it has to be occasionally replaced. The oasys can also rarely pop up alittle bit and irritate your eye. Closing your eyelids tightly will usually push them back into position. But, if you need to remove your plugs due to epiphoria, it is easier to remove the Oasys than the smart plug. I am also willing to place the oasys plug in your two upper puncta as well as your 2 lower puncta should you request more relief from your dry eye symptoms than the lower plugs offer, since I can remove the oasys plugs should epiphoria occur. Because of this, my preference is to fit the Oasys plug. I installed the smart plug in my wife’s eyes after her LASIK procedure and I have the Oasys installed in my lower eyelids.
Restasis is another option. It is a powerful anti-inflammatory that will increase your tear production and relieve some or most of your symptoms, but I’m not a big fan of it for a couple of reasons. Restasis needs to be taken twice a day for the rest of your life, it burns when you put it in and it costs a fair amount per month, even with most insurance plans. I much prefer trying punctal plugs first, which is a two-step process and will relieve a lot of the dry eye symptoms.