Blepharitis: Symptoms, Causes, Treatment, and Diagnosis

Blepharitis is a common eyelid inflammation with a complex set of causes. It is also commonly called lid margin disease because it affects only the edges of your eyelids. It can happen either when certain skin conditions cause irritation or when bacteria results in infection, or a combination.

As a result, your eyelids may become red, swollen and scaly. Blepharitis usually affects both eyes. In some cases it can only affect one eye, but this is uncommon. Once blepharitis occurs, it’s possible to also get a secondary infection. Though uncomfortable, most cases aren’t contagious and won’t cause blindness.

Blepharitis

How common is blepharitis?

Most forms of blepharitis affect adults and children of both genders equally. However, certain forms, such as staphylococcal blepharitis, affect mainly women (80% of cases). A recent survey of ophthalmologists and optometrists reported that nearly half of the patients they see showed symptoms of blepharitis. So it’s good to know that it’s very common and the symptoms are very manageable.

Are there different types of blepharitis?

Blepharitis is defined by its location on your lids.

Two types exist:

Anterior blepharitis: occurs when the eyelid’s front exterior, where eyelashes emerge, is red and swollen.

Posterior blepharitis: perhaps the more common type, happens when the oil (meibomian) glands in the moist underside of the eyelid produce oil erratically.

What are the symptoms of blepharitis?

Blepharitis may make your eyelids feel itchy and look red, swollen and scaly. As the scales become courser, the eyelid surface becomes irritated and forms crusts, which may cause your lids to stick together. You may wake up in the morning with a crust on your eyelashes and eyelid edges that’s heavier than the “sleep” you’re used to seeing. Instead of a normal clear or white, the eye discharge may be more yellow or green in color. If the crust falls into your eye, you may feel like you have “something in your eye,” or your eye may feel gritty.

Other symptoms may include:

• Burning sensation in eyelid area.
• Excessive blinking.
• Blurred vision.
• Crusting of eyelashes and eyelid corners.
• Dry eye.
• Eyelids stuck together.
• Excessive tearing.
• Flakes of skin around eyes and eyelids.
• Greasy eyelids.
• Itching.
• Photophobia (light sensitivity).
• Red, swollen eyelids.
• Red, irritated eyes.

What causes blepharitis?

The causes of blepharitis are not well known and there is rarely a single cause. Bacteria or conditions that cause inflammation are believed to among the culprits.

These include:

Anterior Blepharitis

• Acne rosacea. Rosacea causes facial skin inflammation, including 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 eye. Dry tear ducts can alter bacterial resistance, resulting in infection.
• Lice or mites in eyelashes (Demodicosis). Eyelash follicles and glands become blocked with demodex mites or lice. One study found 30% of chronic blepharitis patients had demodex mites.

Posterior Blepharitis

• Meibomian Gland Dysfunction (MGD). Openings of oil-producing glands in your eyelids become plugged, causing dry eye, which can result in inflammation and infection. This common type may be the least preventable. Posterior blepharitis may also be triggered by skin conditions, such as rosacea or dandruff.

How is blepharitis diagnosed?

Because blepharitis can be caused by so many conditions, it’s difficult to diagnose. There is no one test for this ailment. Here are a few steps your eye care provider may take to diagnose which disease type(s) is present.

1. Health history. The provider will ask about symptoms and other health conditions to determine your risk factors.
2. External eyelid exam. The appearance of the eyelids and intensity of reddening, discharge and swelling will help determine the type and severity.
3. Discharge cultures. A swab of eyelid secretion sent to a lab can determine contents, including what type of bacteria is present and in what quantity.
4. Tear test. A sample of tears can determine if dry eye is a contributing factor.
5. Eyelash exam. Evaluating eyelashes under a microscope can detect mites.
6. Eyelid biopsy. Rarely, extreme swelling may require biopsy to rule out skin cancer or other abnormal cells. The biopsy type is determined by the location of the area being tested. Your eye care provider will numb the lid with local anesthetic. Then a needle biopsy is used to take a sample of cells to be examined under the microscope. You may experience some bruising, but there is usually little or no scarring.

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 infection is under control.
• Use warm compresses. Take a clean wash cloth and wet it with very warm water. Wring out excess water and place it over your eyelids and repeat as necessary to keep the cloth temperature constant. Eventually, the crusts will dampen and oily debris will be easier to wipe away.
• Clean the eyelids. While this may lead to more laundry to do, use a new clean cloth to wash each eyelid. This will help lessen any bacteria spread from one eye to the other.

1. Mix a solution of 50% baby shampoo and 50% water.
2. Place the warm, wet washcloth over your index finger and apply the soapy solution.
3. Close the eye you are cleansing and rub the washcloth over the lashes and lid margins several times using horizontal strokes.
4. Rinse thoroughly with a clean, warm wet washcloth.
5. Repeat for other eye.

If several days of carefully cleaning your eyelids doesn’t curb the crusting, it’s time to see your 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, including:

• Antibiotics. Applying a prescription antibiotic ointment, such as bacitracin ophthalmic (Polysporin®), on your eyelid or using prescription antibiotic eye drops, such as combination polymyxin B and trimethoprim (Polytrim®) may help resolve the bacterial infection and lessen irritation. Sometimes an oral antibiotic is prescribed for more persistent cases.
• Anti-Inflammatories. A steroid eye drop or cream can be added to your treatment plan if your provider thinks you need a stronger medicine. Steroids are prescribed to reduce inflammation. Sometimes both antibiotics and anti-inflammatories are prescribed to treat underlying conditions or secondary infections.
• Immunomodulators. Adding an immunomodulatory drug, such as Cyclosporine Ophthalmic (Restasis®) in cases of posterior blepharitis, has been shown to reduce inflammation. These drugs block the body’s natural immune response and therefore reduce inflammation.
• Root cause treatment. It’s important to treat root causes that trigger blepharitis, in addition to soothing symptoms. Skin conditions — such as dandruff — or eye ailments — such as dry eye — can lead to blepharitis recurring more often. In these cases, a dandruff shampoo or eye drops for dry eyes may help.

What complications can result from blepharitis?

Blepharitis cannot be cured; 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 swelling.
• Corneal ulcer (keratitus). A sore on the cornea can result from prolonged infection or eyelid swelling.
• Eyelash issues. Eyelashes may shed, grow in odd directions, or lighten as a result of chronic blepharitis.
• Pink eye. Some types of blepharitis may turn into chronic pink eye.
• Sty (stye). A sty (stye) is a red, painful eyelid bump near the eyelashes.
• Tear film issues. Tears exist in a delicate balance of mucous, oil and water to keep eyes moist and protected. If skin or oily debris accumulate and cause irritation, dry eyes or excessive tearing can result.

How do I prevent blepharitis?

Most blepharitis cases are not preventable. Some risk factors for blepharitis, such as certain skin conditions, are beyond your control. But to minimize blepharitis’s symptoms, here are everyday steps you can take:

• Keep hands and face clean.
• Resist the urge to touch itchy eyes/face. Use a clean tissue if you must.
• 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.