BlephEx treatment: professional cleaning of the eyelid margins

On this page

1. What BlephEx treatment is
2. Why cleaning at home is sometimes not enough
3. Who the treatment may suit, and who it may not
4. How to prepare for the treatment
5. How the treatment is done at the clinic, step by step
6. What it feels like, and what happens after the treatment
7. Possible side effects and risks
8. What to do at home after the treatment
9. How the treatment fits with other treatments
10. Cost

This page is for people who suffer from eyelid inflammation that keeps coming back, scales on the eyelashes or itching at the eyelid margins, despite cleaning at home. Here you will find what BlephEx treatment is, who it may suit, how it is done and what to expect afterwards.

What BlephEx treatment is

BlephEx is a handheld device for professional cleaning of the eyelid margins. At the tip of the device is a small, single-use sponge that spins quickly, and it is used to gently clean the eyelid margin and the base of the eyelashes. The cleaning removes a sticky layer of bacteria and debris (biofilm, a layer that bacteria form on a surface), scales and oil residue that are hard to remove with cleaning at home. The cleaning may also unblock the openings of the meibomian glands, which are at the eyelid margin.

Why cleaning at home is sometimes not enough

Daily eyelid cleaning at home is the basis of blepharitis treatment. But over time a sticky, hard layer can build up on the eyelid margin that wipes or cotton buds cannot remove. This layer shelters bacteria and Demodex, irritates the eyelid and may block the gland openings. This creates a cycle: the inflammation causes build-up, and the build-up feeds the inflammation.

Professional cleaning at the clinic removes this layer in one go, so the home cleaning that follows starts from a "clean slate" and may be more effective.

Who the treatment may suit, and who it may not

The treatment may suit people who have:

• Blepharitis (chronic inflammation of the eyelid margins) that does not improve enough with cleaning at home.
• Demodex, a tiny mite that lives at the base of the eyelashes, with sleeve-like scales around the lashes and itchy eyelids.
• A build-up of scales and residue on the eyelid margins that contributes to dryness and irritation.
• Recurring styes or chalazia linked to inflammation of the eyelid margin.

Sometimes it is better to postpone the treatment, for example when there is an acute infection of the eye or eyelid, an active inflamed stye, a wound on the eyelid margin, or after recent eye surgery. The decision is made after an examination.

How to prepare for the treatment

• Come without eye make-up, especially without mascara and eyeliner.
• If you wear contact lenses, you may be asked to remove them before the treatment. Bring a case and solution.
• Tell us about drops or ointments you use, previous eye surgery and sensitivity to substances.
• If you have eyelash extensions or false eyelashes, tell us in advance.

How the treatment is done at the clinic, step by step

1. Examination. The eyelid margins, eyelashes and glands are examined as part of dry eye testing, and we look for signs of Demodex.
2. Numbing drops. Local anaesthetic drops are put in to make the treatment more comfortable.
3. Cleaning. The single-use sponge is moistened with a cleaning solution and moved along the upper and lower eyelid margins of each eye, taking care not to touch the eye itself.
4. Rinsing. The eye and eyelids are rinsed to remove the residue.
5. Guidance. We explain how to clean your eyelids at home and, if needed, what further treatment will be given.

The treatment is relatively short and is usually done in one session for both eyes.

What it feels like, and what happens after the treatment

Most patients feel vibration and tickling at the eyelid margin, and sometimes a mild stinging. Thanks to the numbing drops, the treatment is usually not painful. Once the numbness wears off, the eyelids may be slightly red and tender, and the eye may water or feel irritated, usually for about a day.

Until the numbness wears off, do not rub your eyes. Many people feel their eyelids are "clean" and lighter after the treatment, but improvement in symptoms may come gradually.

Possible side effects and risks

• Redness, tenderness and temporary irritation of the eyelid margins.
• Watering and a foreign-body sensation for a short time.
• Rarely, a scratch on the surface of the eye if the sponge touches it. If after the treatment you develop increasing pain, strong sensitivity to light or reduced vision, contact the clinic or an eye doctor.

It is important to know: mechanical cleaning of the eyelid margins is an accepted part of blepharitis treatment, but research on the device itself is still limited, and the response varies between patients.

What to do at home after the treatment

• Continue daily cleaning of the eyelid margins, according to the guidance you receive, even when you feel well.
• If a specific Demodex treatment or an ointment has been prescribed, use it throughout the whole period set, because the mite reproduces in cycles.
• Change towels and pillowcases regularly, and do not share towels or eye make-up with others.
• Replace old mascara and eyeliner, and remove make-up before sleep.
• If the itching, scales or redness come back quickly after the treatment, mention it at your follow-up visit. This helps decide whether to add treatment or change the frequency.

How the treatment fits with other treatments

BlephEx is one tool within a broader plan, not a treatment that stands on its own. The basis is daily eyelid cleaning and warming at home, according to the guidance you receive. When there are also blocked meibomian glands, the treatment is often combined with meibomian gland expression, and sometimes with IPL treatment. When there is Demodex, the eye doctor may prescribe an additional specific treatment. In severe inflammation, the doctor may also prescribe anti-inflammatory drops or ointments.

The in-clinic treatment is sometimes repeated every few months, as needed and according to what is seen at follow-up visits.

Cost

The cost is set and discussed at the consultation, according to the treatment that suits you.

Want a basic explanation first?For basic information on blepharitis: the guide on the Mitzmutz site

Frequently asked questions

Does BlephEx treatment hurt?

Usually not. Numbing drops are put in beforehand, and most patients feel vibration and tickling at the eyelid margin. Some feel a mild stinging.

How often is the treatment repeated?

It depends on how severe the inflammation is and how quickly the debris builds up again. Some people come back every few months and some less often. The frequency is decided at follow-up visits.

Does BlephEx replace eyelid cleaning at home?

No. The in-clinic treatment removes what has built up, but daily cleaning at home, according to the guidance you receive, is what maintains the result.

Does the treatment get rid of Demodex?

The cleaning removes the scales and debris in which the mite lives and may reduce its numbers, but a specific treatment for use at home, which the doctor may prescribe, is usually needed as well, and Demodex sometimes comes back.

Sources

1. Amescua G, Akpek EK, Farid M, et al. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019;126(1):P56-P93.
2. Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. Curr Opin Allergy Clin Immunol. 2010;10(5):505-510.
3. Korb DR, Blackie CA. Debridement-scaling: a new procedure that increases Meibomian gland function and reduces dry eye symptoms. Cornea. 2013;32(12):1554-1557.
4. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.

The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.