Blepharitis is the medical term for eyelid inflammation. It’s a common condition that can be acute or chronic (long-lasting). Blepharitis causes red, swollen eyelids as well as itching and crusting of the eyelid margins.
Chronic blepharitis can be difficult to treat but is not contagious or vision-threatening. Having certain skin conditions can make you more likely to develop blepharitis.
What Are the Different Types of Blepharitis?
There are two main types of blepharitis:
Anterior Blepharitis
This type affects the eyelid skin, eyelash follicles, and base of the eyelashes. Anterior blepharitis can be caused by:
- Dandruff (seborrheic blepharitis)
- Bacterial infection (staphylococcal blepharitis)
Posterior Blepharitis
This type affects the oil-producing meibomian glands beneath the eyelid (meibomian blepharitis). Posterior blepharitis has a range of possible causes, but meibomian gland dysfunction is the most common.
How Common Is Blepharitis?
Blepharitis is very common and occurs in people of all ages. Ophthalmologists and optometrists report that 37 to 47 percent of their patients have signs of blepharitis.5
What Causes Blepharitis?
The exact cause of blepharitis is unknown. Scientists believe that inflammation and bacteria are major contributing factors. Blepharitis often occurs with infections, meibomian gland dysfunction, and certain skin conditions.
Anterior Blepharitis Causes
Conditions commonly associated with anterior blepharitis include:
- Acne rosacea. This skin condition causes redness and inflammation. When it affects the eyes and eyelids, it’s called ocular rosacea.
- Seborrheic dermatitis. This is the medical term for dandruff, which is flaky, oily skin that usually affects the scalp. Dandruff flakes can irritate the eyelid skin.
- Dry eyes (dry eye disease). A healthy tear film helps keep your eyes clean; dry eyes are more susceptible to bacterial infection.
- Allergies. An allergic reaction to medications, beauty products, pets, or environmental allergens can cause acute blepharitis.
- Infection. Acute blepharitis can be caused by bacteria (staphylococcal blepharitis) or a viral infection, such as herpes simplex.
- Demodex infestation. An infestation of Demodex mites (eyelash mites) can block eyelash follicles and glands, leading to chronic blepharitis.
Posterior Blepharitis Causes
Meibomian gland dysfunction is the most common cause of posterior blepharitis. This condition occurs when there’s a problem with the meibomian glands or the oil they secrete. Oil from meibomian glands plays a key role in slowing the evaporation of the tear film.
Skin conditions like rosacea and dandruff can also contribute to posterior blepharitis.
Does LASIK Cause Blepharitis?
LASIK doesn’t cause blepharitis. However, getting LASIK can aggravate symptoms in people who have chronic blepharitis.
If you have blepharitis, your eye doctor will likely recommend treating the condition before you get LASIK. This is because LASIK tends to cause dry eye syndrome, which worsens the symptoms of blepharitis.
How Is Blepharitis Diagnosed?
Eye and general doctors can diagnose blepharitis and determine the proper treatment. Typically, an eye exam is needed to diagnose this condition.
Your doctor will carefully examine your eyes and lid margins. They may take a sample of your eyelashes, skin flakes, or discharge for additional testing.
Rarely, your doctor may take an eyelid biopsy (tissue sample) to rule out skin cancer.
Blepharitis Symptoms
Blepharitis symptoms vary from person to person, depending on the cause. Symptoms are typically worse in the morning.
Generally, they include:
- Itchy eyes and eyelids
- Swollen eyes and eyelids
- Red eyes and eyelids
- Burning sensation
- Misdirected eyelashes
- Greasy flakes of skin around the base of the eyelashes
- Feeling like something is stuck in your eyes
- Crusty eyes
- Crust along the eyelid margin
- Sensitivity to light
- Excessive tearing
- Blurred vision
- Frequent blinking
You may have many or very few of these symptoms. But they should get better within a few weeks with treatment.
Blepharitis Risk Factors
In addition to rosacea and dandruff, the following conditions may increase your risk for blepharitis:
- Oily skin
- Diabetes
- Wearing contact lenses
- Sleeping in eye makeup
- Hormonal changes, such as menopause
- Exposure to environmental irritants, such as dust
- Taking certain medications, such as cancer treatment
What Complications Are Associated with Blepharitis?
Untreated blepharitis can lead to more serious eye conditions, including:
- Stye (a small, red, and painful lump along the eyelid margin)
- Chalazion (eyelid cyst)
- Clogged oil glands
- Dry eyes
- Chronic pink eye (conjunctivitis)
- Corneal ulcers
- Corneal scarring
- Excess tearing
- Scarring of the skin surrounding the eyes
Is Blepharitis Preventable?
Many blepharitis cases, such as those caused by skin conditions, can’t be prevented. Even with successful treatment, blepharitis may never go away completely.
Here are steps you can take to help manage blepharitis:
- Keep your eyes, skin, and scalp clean
- Avoid touching your eyes
- Use a clean tissue to wipe excess tears or eye drops
- Wash your hands with soap and warm water before touching your face
- Always remove eye makeup and wash your face before bed
- Replace eye makeup that’s expired
- Treat dandruff with an anti-dandruff shampoo
- Wear glasses instead of contact lenses until blepharitis clears
Prognosis
Blepharitis can be an acute or chronic condition. As a chronic disease, blepharitis goes through periods of improvement and worsening symptoms. Even if symptoms subside, they may flare up again.
Most blepharitis cases can be managed with good skin and eyelid hygiene. Rarely, severe cases of blepharitis can permanently affect vision or the eyelid margin.
How Is Blepharitis Treated?
Blepharitis treatment varies based on the cause, severity of your symptoms, and any associated complications you may be experiencing. With proper eyelid hygiene and warm compresses, a blepharitis flare-up may resolve quickly in a few days.
Depending on your needs, treating blepharitis may include:
Home Remedies
Self-care may be the only blepharitis treatment you need. Home remedies include:
Eyelid Hygiene
Gently scrub your eyelids with warm water and an over-the-counter eyelid cleanser twice daily. Lid scrubs are available as foams, sprays, and individually wrapped wipes.
You can make your own cleanser by diluting baby shampoo with equal parts water. Apply it with a clean, wet washcloth wrapped around your index finger, or use a clean cotton swab.
Other Personal Care Tips
In addition to eyelid cleansing, wash the skin on your face before going to bed. Avoid wearing eye makeup until the blepharitis clears.
If you have dandruff on your scalp, treat that with an anti-dandruff shampoo.
Warm Compresses
Apply warm compresses for about 5 minutes to loosen eyelid crust and oily debris. Moisten a clean washcloth with warm water and place it over your closed eyelid. Alternatively, you can use a microwavable heat pack made for the eyes.
Artificial Tears
Lubricating eye drops won’t treat eyelid crust or flaking skin but can relieve dry eye symptoms. Artificial tears can also relieve blepharitis symptoms like redness and irritation.
Omega-3 Fatty Acids
Foods rich in omega-3s, such as salmon and chia seeds, help keep your meibomian glands healthy. You can also buy omega-3 supplements over the counter.
Professional Treatments
Severe cases of blepharitis may not resolve with home remedies. Call your doctor if symptoms don’t improve after cleaning your eyelids carefully for several weeks.
Your healthcare provider will determine the best treatment after examining your eyelid. Treatment may include:
Topical Antibiotics and Anti-inflammatories
A prescription antibiotic ointment may help clear up staphylococcal blepharitis. Persistent infections may require an oral antibiotic.
Steroid eye drops or ointments may help reduce inflammation in acute blepharitis cases. Your doctor may prescribe a combined steroid and antibiotic to treat infection and inflammation.
Treating Skin Conditions
If a skin condition is causing seborrheic blepharitis, your doctor will prescribe the appropriate treatment. These conditions include rosacea, seborrheic dermatitis, and other diseases.
Intense Pulsed Light (IPL) Therapy
IPL is a professional skin care treatment for conditions such as rosacea. It may also relieve symptoms of meibomian gland dysfunction and dry eye disease.
Summary
Blepharitis is inflammation of the eyelids. It can cause swelling, redness, flaky skin, and crusting of the eyelid margins.
Many conditions are associated with blepharitis, including rosacea, dandruff, meibomian gland dysfunction, dry eye, and infestation of Demodex mites.
Chronic blepharitis may never go away entirely, but symptoms can be managed. Good eyelid hygiene goes a long way in managing symptoms and resolving flare-ups.
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