Blepharitis, Non-Infectious (Swollen Eyelids)

What Is Non-Infectious Blepharitis?

[dropcap]N[/dropcap]on-infectious blepharitis is an inflammatory condition of the eyelids that is NOT caused by an invading organism but rather nutritional deficiencies. It is characterized by non-ulcerative inflammation of the hair follicles and lacrimal glands along the eyelid edges.

Q: What  is the difference between inflammation and an invading organism which causes inflammation?

A: An invading organism such as Staphylococcus aureus, a common bacteria on the body’s surface, is called a stye. Styes are treated with antibiotics and resolve. Whereas, non-infectious blepharitis does not respond to antibiotics because there is no infection.

The eyelids are an important structural defense against infection and threats to the eye through blinking and tear production. Their continual pattern of blinking every few seconds sweeps away debris and keeps the eye moistened with tears.

Tears are made by the meibomian glands in the eyelids and consist of fatty acids, water and mucous and also contain anti-microbial substances.

Failure of the meibomian glands to function properly, called meibomian gland dysfunction or MGD, is a chronic, diffuse abnormality characterized by terminal duct obstruction (plugs) and/or changes in the amount or quality of the glandular secretion called meibom (tears). This may result in alteration and/or insufficiency of the tear film, symptoms of eye irritation, clinically apparent inflammation, and disease of the eye surface.

What Is Non-Infectious Blepharitis In Celiac Disease and/or Gluten Sensitivity?

• Non-infectious blepharitis is a feature of vitamin A, EPA (omega-3 fatty acid), and protein deficiencies associated with malabsorption in celiac disease.
• Blepharitis often occurs with seborrhea of the skin and both conditions involve vitamin A deficiency.

How Prevalent is Non-Infectious Blepharitis In Celiac Disease and/or Gluten Sensitivity?

Non-infectious blepharitis has increased frequency in patients with untreated celiac disease.

What Are The Symptoms Of Non-Infectious Blepharitis?

Non-infectious blepharitis is marked by these symptoms:

• Redness, thickening, and tenderness of the eyelids with exudate (pus).
• Scaling and flaking on the lid edges.
• Sometimes there is burning.

How Does Non-Infectious Blepharitis Develop In Celiac Disease and/or Gluten Sensitivity?

• Blepharitis develops from vitamin A,  EPA (omega-3 fatty acid), and protein deficiency due to malabsorption in celiac disease.

Does Non-Infectious Blepharitis Respond To Gluten-Free Diet?

Yes. Celiac disease-related non-infectious blepharitis resolves on nutritious gluten free diet containing adequate vitamin A with EPA (omega-3 fatty acid) and protein. Vitamin A supplementation may be required because this deficiency also causes other eye problems some of which are severe.

6 Steps To Improve Non-Infectious Blepharitis In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both eyelid and gut health.

Treatment for gluten sensitivity:

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery from gluten. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹
• The intestinal lining may take up to a year to heal.[checklist]

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Reduce Inflammation. Foods to Eat and Foods Not to Eat:

 

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

 

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

 

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.²

 

• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.

 

• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.²

 

• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil.

 

Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.².

 

• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.²

 

• Refined Sugars.  Includes white cane sugar, corn fructose and high fructose corn syrup.

 

• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.²

 

• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.²[/box]

 

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

 

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.

 

• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.

 

• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.

 

• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability.

• Includes vitamin C-containing foods such as oranges, pineapple, lemon, grapefruit, apricot, Brussels sprouts, blackberries, strawberries, and others.
• Includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.

 

• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.

 

• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.

 

• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.

 

• Protective Herbs and Spices.  See below #6 below for examples.[/box]

 

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

 

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Certain prescription drugs can cause nutritional deficiencies that increase risk for this blepharitis. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 

This is not a complete listing.

 

WEIGHT LOSS DRUGS THAT BIND FAT also interfere with absorption of some nutrients.

• Zenicol (Orlistat®) depletes Vitamin A.

 

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Vitamin A, and others.

 

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Vitamin A, and others.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Vitamin A, and others.[/box]

 

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

 

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

 

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels.  Do not use preparations with retinyl acetate as the vitamin A because it is derived from benzene. Only retinyl palmitate is safe. Always check with your doctor to avoid interactions with medications.

 

• Vitamin A in the form of retinal palmitate as prescribed following a blood test for vitamin A status.

 

• Fish oil supplements to restore EPA status.

 

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

 

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

 

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.

 

• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.

 

• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.

 

• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

 

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

 

Carminative Food Remedies:

 

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

 

Carminative Herb Remedies:

 

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

 

Carminative Spice Remedies:

 

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

 

[box type=”shadow” ]Exercise Helps:

 

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

 

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

 

What Do Medical Research Studies Tell About Non-Infectious Blepharitis In Celiac Disease and/or Gluten Sensitivity?

 

RESEARCH STUDY SUMMARIES

 

“A randomized, double-masked study to evaluate the effect of omega-3 fatty acids supplementation in meibomian gland dysfunction.” This randomized and double-masked study investigating the effectiveness of omega-3 fatty acids versus placebo, in improving the symptoms and signs of meibomian gland dysfunction found that oral omega-3 fatty acids, 1.5 grams per day, may be beneficial in the treatment of meibomian gland dysfunction, mainly by improving tear stability.

 

Enrolled were 61 patients who presented with symptomatic MGD and no tear instability (defined as tear breakup time [TBUT] <10 seconds). Participants were randomly assigned to two homogeneous subgroups. For patients in group A, the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives, plus a placebo oral agent. For patients in group B, the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives, plus oral supplementation with omega-3 fatty acids. We performed the following tests: (1) TBUT; (2) Schirmer I test; (3) Ocular Surface Disease Index© (OSDI©; Allergan, Inc., Irvine, CA, USA); (4) MG expression; (5) evaluation of lid margin inflammation; and (6) interpalpebral and corneal dye staining.

 

After 3 months of evaluation, the mean OSDI, TBUT, lid margin inflammation, and MG expression presented improvement from the baseline values, in group B. The Schirmer test results were also improved and statistically significant.³

 

“Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.” This study aiming to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult celiac disease (CD)-patients in the Netherlands found that vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Eighty newly diagnosed adult CD-patients were included and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations.

 

Nutritional status and serum concentrations of  various nutrients including vitamin A were assessed before prescribing gluten free diet. Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B₁₂. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.⁴

 

 

Sources:

1. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
2. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
3. Oleñik A, Jiménez-Alfaro I, Alejandre-Alba N, Mahillo-Fernández I. A randomized, double-masked study to evaluate the effect of omega-3 fatty acids supplementation in meibomian gland dysfunction. Clin Interv Aging. 2013;8:1133-8. doi: 10.2147/CIA.S48955. [↩]
4. Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390/nu5103975. [↩]