Blepharitis

What is blepharitis?

Blepharitis, pronounced bleh-fur-RY-tis, means inflammation of the eyelid. The edges of your lids turn red or dark in color and become swollen and scaly. Blepharitis usually affects both eyes. It can happen when a skin condition causes irritation, when you develop an infection or when oil glands become clogged. All of these things can even happen at once.

Blepharitis is a term for inflammation, but it can lead to an infection in your eye. However, most cases of blepharitis aren’t contagious. They aren’t likely to lead to blindness.

How common is blepharitis?

A survey of ophthalmologists and optometrists reported that nearly half of the people they see showed symptoms of blepharitis. The condition is common and symptoms are manageable.

Blepharitis typically affects adults and children of both sexes equally. However, one form — staphylococcal blepharitis — mainly affects women and people assigned female at birth (AFAB). This is true of about 80% of cases.

Are there different types of blepharitis?

There are two types of blepharitis, depending on where it’s located on your eyelids. They are:

• Anterior blepharitis: This type occurs when your eyelid’s front exterior, where the eyelashes come out of your lids, is red or darker in color and swollen, or when you have dandruff on your lashes.
• Posterior blepharitis: This type happens when the oil-producing meibomian glands under your eyelid produce thickened/unhealthy oil.

What are the signs and symptoms of blepharitis?

There are several signs and symptoms of blepharitis. They may include:

• Swollen eyelids and/or greasy eyelids.
• Red, irritated eyes that itch or burn.
• Crusting of eyelashes and eyelid corners, making your eyelids stick together.
• Flakes of skin collecting around your eyes and eyelids.
• Dry eye or excessive tearing.
• Excessive blinking.

Other signs and symptoms may include:

• Photophobia (light sensitivity).
• Blurred vision.
• Loss of eyelashes.
• Eyelashes that grow toward your eyes rather than away from them (trichiasis).

What causes blepharitis?

Blepharitis can happen if you have issues with the meibomian glands that produce the oils found in tears, certain skin conditions or infections.

Causes of anterior blepharitis

• Acne rosacea: Rosacea causes facial skin inflammation, which can include your eyelids.
• Allergies: Allergies to contact lens solution, eye drops or makeup can spur irritation.
• Dandruff (seborrheic dermatitis): Dandruff flaking can irritate eyelids and cause inflammation.
• Dry eyes: Dry tear ducts can alter bacterial resistance, resulting in infection.
• Lice or mites in eyelashes (demodicosis): Lice or Demodex mites can block eyelash follicles and glands in your eye. One study found that 30% of people with chronic blepharitis had Demodex mites.

Causes of posterior blepharitis

• Meibomian gland dysfunction (MGD): When the oil from meibomian glands doesn’t flow freely, you can develop dry eye, which can result in inflammation and infection.
• Acne rosacea.
• Dandruff.

The symptoms you have may indicate a particular type of blepharitis: staphylococcal, seborrheic, ulcerative or meibomian. For instance:

• Seborrheic blepharitis has symptoms that include greasy flakes.
• Ulcerative blepharitis may cause bleeding when you remove crusts.
• Meibomian blepharitis causes your tears to be of poor quality.
• Staphylococcal blepharitis symptoms may include missing eyelashes or lashes that point the wrong way.

What are other risk factors for developing blepharitis?

In addition to having rosacea and dandruff, you may be more at risk of developing blepharitis if you:

• Have diabetes.
• Wear contact lenses.
• Are exposed to irritants like dust and chemicals.
• Work or live in dry environments. This includes spending a lot of time in air conditioning.
• Have a high number of microbes that normally live on your skin.
• Don’t remove makeup thoroughly.
• Have oily skin.
• Are on certain drugs such as those for cancer treatment.
• Are going through menopause or hormonal changes.

Do poor hygiene habits cause blepharitis?

Poor hygiene can be a factor in blepharitis, but it’s not as simple as saying that only people with poor hygiene can get blepharitis. Hygiene is just a part of the reason that some people get blepharitis.

If you think about it, most people don’t clean their eyelids and lashes every day or night. However, people with risk factors may have to make eyelid and eyelash hygiene a priority.

How is blepharitis diagnosed?

There’s no single test for blepharitis. Here are a few steps your eye care provider may take to find out if you have blepharitis and what type it is:

1. Take a health history: The provider will ask about symptoms and other health conditions to determine your risk factors.
2. Do an external eyelid exam: The appearance of your eyelids and intensity of reddening, discharge and swelling will help determine the type and severity.
3. Take cultures of discharge: A swab of eyelid secretion sent to a lab can determine contents, including what type of bacteria is present and in what quantity.
4. Do a tear test: A sample of tears can determine if dry eye is a contributing factor.
5. Do an eyelash exam: Evaluating eyelashes under a microscope can detect mites.
6. Perform an eyelid biopsy: Rarely, your provider may need to do a biopsy to rule out skin cancer or other abnormal cells. Your eye care provider will numb your lid with local anesthetic. Then they’ll use a needle to take a sample of cells to examine under a microscope. You may bruise, but you’re not likely to have a scar.

Can I treat my blepharitis at home?

For some types of blepharitis, self-care at home may help soothe the symptoms. If you believe you have blepharitis, try these tips:

• Avoid eye makeup: To lessen irritation, you may want to avoid eye makeup until the inflammation is managed.
• Use warm compresses: Take a clean washcloth and wet it with very warm water. Wring out excess water, and place the cloth over your eyelids. Repeat this as necessary to keep the cloth temperature constant. Eventually, the crusts will dampen and oily debris will be easier to wipe away. Commercially available microwavable heat masks can hold heat longer and may be more effective.
• Get some omega-3s: Some studies have found that omega-3s, found in fish or flax seed oil, will help the glands in your eyes work better. Eating green, leafy vegetables and avoiding high fat foods can also be helpful.
• Lid scrubs: These are available over the counter as a spray, foam or individually wrapped towelettes, often containing hypochlorous acid. They help reduce dandruff on your lashes and the bacterial numbers on your eyelid skin.

Alternatively, you can make your own lid scrubs at home. Follow these steps:

1. Use a new clean cloth to wash each eyelid. This will help lessen any bacteria spread from one eye to the other.
2. Mix a solution of 50% baby shampoo and 50% water.
3. Place the warm, wet washcloth over your index finger and apply the soapy solution to the cloth.
4. Close the eye you’re cleansing and rub the washcloth over the lashes and lid margins several times using horizontal strokes.
5. Rinse thoroughly with a clean, warm wet washcloth.
6. Repeat for your other eye.

If cleaning your eyelids carefully for several days doesn’t get rid of the crusts, you should see an eye care provider.

How will an eye care provider treat my blepharitis?

Your blepharitis treatment will depend upon the type you have. After examining your eyelid swelling and running tests, your provider may prescribe treatments that include some or all of the following.

Antibiotics to treat blepharitis

You may get a prescription for an antibiotic ointment — such as erythromycin, bacitracin ophthalmic or Polysporin® for your eyelid — or for antibiotic eye drops, such as a combination of polymyxin B and trimethoprim (Polytrim®). These treatments may help resolve the bacterial infection and reduce irritation. Cases that persist may require an oral antibiotic, such as doxycycline or azithromycin.

Anti-inflammatories to treat blepharitis

Your provider may add a steroid eye drop or cream to your treatment plan if you need stronger medicine. Steroids reduce inflammation. Your provider may prescribe both antibiotics and anti-inflammatories to treat underlying conditions or secondary infections.

Immunomodulators to treat blepharitis

Adding an immunomodulatory drug, such as cyclosporine ophthalmic (Restasis®) in cases of posterior blepharitis, has been shown to reduce inflammation. These drugs block your body’s natural immune response and therefore reduce inflammation.

Treating blepharitis by treating the root cause

It’s important to treat root causes that trigger blepharitis, in addition to soothing symptoms. Skin conditions (such as rosacea) or eye ailments (such as dry eye) can lead to blepharitis recurring more often. In these cases, certain pills, skin creams, or eye drops for dry eyes may help.

Treating blepharitis with clinical procedures

Your provider can do some newer procedures in their office. These include:

• Lipiflow®, which warms up the lids and expresses the unhealthy oils.
• Intense Pulsed Light therapy, which involves the application of bright red light pulses to your eyelid skin.
• BlephEx®, which involves cleaning your eyelid margins.

What complications can result from blepharitis?

You can’t cure blepharitis. However, it can be treated and controlled through proper eyelid hygiene. Left untreated, blepharitis may lead to other more serious eye conditions, including corneal problems, which may be significant.

Complications include:

• Chalazion: A chalazion is a small, painless eyelid bump/swelling.
• Corneal ulcer (keratitis): A sore on your cornea can result from prolonged infection or eyelid swelling.
• Eyelid issues: Eyelashes may shed, grow in odd directions or lighten because of chronic blepharitis.
• Pink eye (conjunctivitis): Some types of blepharitis may turn into chronic pink eye.
• Sty (stye): A sty (stye) is a red, painful eyelid bump near your eyelashes.
• Tear film issues: Tears exist in a delicate balance of mucus, oil and water to keep your eyes moist and protected. If skin or oily debris accumulates and causes irritation, you can develop dry eyes or excessive tearing. Healthy oils secreted by the eyelid margin help protect the tears from evaporating. Dry eye can get worse when blepharitis causes you to excrete unhealthy oils.

How do I prevent blepharitis?

Many blepharitis cases aren’t preventable. Some risk factors for blepharitis, such as certain skin conditions, are beyond your control. Here are some steps you can take every day to help with the symptoms:

• Keep your hands, face and scalp clean.
• Try not to touch your itchy eyes or your face. Use a clean tissue if you must touch them.
• Remove all eye makeup before bedtime.
• Wipe away excess tears or eye drops with a clean tissue.
• Wear glasses instead of contact lenses until the condition clears.
• Use artificial tears if you have dry eyes and your provider agrees.
• Use anti-dandruff shampoo to wash your hair.
• Replace eye makeup — eyeliner, eye shadow, mascara — because they may have bacteria in the containers. You want to avoid reinfection.

A note from Cleveland Clinic

Blepharitis, with its symptoms of swollen, red, itchy eyelids, is never fun. However, in most cases, blepharitis is a condition that you can manage. If you can treat any underlying issues, and you practice good eyelid hygiene, you’ll likely have fewer flare-ups.