Does DE caused by blepharitis act differently?

[Ariel]

I 'd like to know which of you are suffering from DES caused by blepharitis because I'm interested in learning if this particular type of DE --which is my DE-- has a different nature, behavioral pattern, and way of manifesting that requires a treatment different from the medical treatment required by DE caused by Lasik, allergies, induced by certain meds, hormonal deficiency, old age, etc.

Does blepharitis always cause DE? Can blepharitis come and go causing DE sometimes but not every time?

[indrep]

Ariel,
Blepharitis can be the original cause of dry eye by impacting the secretions of lipids and increasing the evaporation rate of your aqueous. The next thing that happens is your tear film is HYPERTONIC. Hypertonic tears do two things, signal the brain to start inflammation and kills the outer layer epithelial cells of your cornea.

Lets address the inflammation first. Once the inflammation starts this suppresses the lacrimal glands ability to secrete aqueous(water). This increases the hypertonicity of the tear film further leading to more inflammation. It is also theorized that it exacerbates the lipid production by inflaming the meibomian glands. So now your anterior blepharitis has moved to the meibomian glands directly.

Secondly I mentioned the epithelial cells were being killed by the hypertonic tear film. What this means to your ocular surface is the mucin layer is not able to hold the aqueous on the ocular surface.

So to answer your question, blepharitis induced dry eye can feel different ways as the disease progresses. Therefore new and different meds, plugs, lifestyle changes, etc. may be needed to increase comfort and maintain cornea health. Finding the right combination that works for each individual to keep water on the eye and then giving it the time to reverse the osmolarity is critical to long term success.