What is blepharitis?

If you’re experiencing redness, burning, itchiness, or crusting areas on your eyelids, you might wonder if you have blepharitis. What is blepharitis? A condition where your eyelids and eyelid margins become inflamed. 

The condition is usually chronic, meaning that it tends to recur. It’s treatable, though, with at-home remedies and medications.

Although having blepharitis can be irritating and uncomfortable, it rarely leads to serious complications, especially if you treat the condition promptly.

What causes blepharitis?

“The causes of blepharitis depend on which type of blepharitis you have,” says Diane Hilal-Campo, MD, ophthalmologist and founder of Twenty/Twenty Beauty.

According to the American Optometric Association, there are two main types of blepharitis: anterior and posterior:

• Anterior blepharitis affects the area of your eyes where your eyelashes are located (eyelid margins).
• Posterior blepharitis affects the part of the eyelid that touches your eyeball.

 “The causes of blepharitis depend on which type of blepharitis you have,” says Dr. Hilal-Campo. “For example, anterior blepharitis is usually caused by bacterial overgrowth and seborrheic blepharitis (eyelid inflammation), whereas posterior blepharitis is usually caused by clogging of the meibomian glands.” Those are the oil glands along the eyelids where the eyelashes are located.

Bacterial infection

The most common infectious cause of blepharitis is overgrowth of staphylococcal bacteria, but infection with Herpes simplex and Varicella zoster may also occur. “Bacteria produce toxins,

which leads to eyelid inflammation,” explains Julia Giyaur, MD, ophthalmologist and founding director at New York Laser Vision.

Seborrheic dermatitis

People with anterior blepharitis often have seborrheic dermatitis. “Just like any other skin, eyelids can be affected by seborrhea, a common skin condition that affects skin’s oil-producing sebaceous glands, leading to oily, flaky skin,” Dr. Giyaur says. The condition is similar to dandruff on the scalp, where flakes accumulate on your eyelashes and cause irritation, she describes.

Allergic reactions

Another common cause of blepharitis is an allergic reaction, according to Parres Wright, OD, FAAO, optometrist and full-time associate professor at Midwestern University-Chicago College of Optometry. “These types of reactions to substances like makeup, contact lens solutions, or airborne allergens cause redness, swelling, and flaking of skin on the eyelids,” says Dr. Wright. If you are having blepharitis symptoms after using certain items, you should avoid them going forward, Dr. Wright recommends.

Meibomian gland dysfunction

The meibomian glands are responsible for secreting oil to prevent dry eyes and tear evaporation. When they become dysfunctional and get blocked, they stop releasing oil, causing irritation. “This leads to increased evaporation, dry eye, and irritation because of lack of eye lubrication,” Dr. Giyaur says.

Demodex mites

Anterior and posterior blepharitis can both be caused by Demodex mites. These cases are called Demodex blepharitis. 

“Demodex are tiny mites that can infect the eyelids,” says Dr. Giyaur. “The mites live in the follicles at the base of the eyelashes and cause inflammation, which leads to blepharitis and lash loss.”

 It’s not entirely clear the role that these mites play in the development of blepharitis because people with and without symptoms seem to have Demodex mites at equal rates.

Symptoms

The symptoms of blepharitis vary from person to person. Additionally, they depend on the type of blepharitis and how well-controlled it is.

 According to the National Eye Institute at the National Institutes of Health (NIH), the most common symptoms of blepharitis are:

• Red eyes
• Swollen eyes or eyelids
• Excessively watery eyes
• The sensation that there’s a foreign object in your eye
• Burning eyes
• Itchy eyes
• Light sensitivity
• Unusual tearing that may be described as foamy or containing tiny bubbles
• Dry eyes
• Increased crust or flakes on your eyelids when you wake up in the morning

“It’s also possible to lose your eyelashes if you have blepharitis,” says Dr. Giyaur. “This typically occurs late in the progress of the disease and is irreversible.” It’s caused by “persistent inflammation of the eyelids, which leads to permanent loss of eyelash follicles,” Dr. Giyaur explains. 

Complications

In most cases, blepharitis isn’t serious and rarely causes complications like vision loss. “Still, it can cause other uncomfortable side effects,” says Dr. Giyaur. 

Styes

One of the most common complications of blepharitis is styes, which are small, tender red bumps that appear on your eyelid. They, too, can be located on the anterior or posterior aspect of the lid. “Styes occur as a result of the inflammation of blocked oil glands, leading to the development of a painful lump on the eyelids,” Dr. Wright explains. 

Chalazions

A chalazion is another type of lump on your eye, but it’s less painful than a stye and typically harder, according to the National Eye Institute. Chalazions are also caused by blockages in your oil gland and often occur when you have a stye that doesn’t resolve. Thankfully, chalazions usually go away on their own.

Pink eye (conjunctivitis)

“Common complications of blepharitis include blepharoconjunctivitis, which mimics pink eye but is treated differently,” explains Yuna Rapoport, MD, an ophthalmologist at Manhattan Eye. Treatments for blepharoconjunctivitis are usually the same as general blepharitis treatment, including keeping the eye area clean and using medication typically prescribed for blepharitis.

Dry eyes

As per the National Eye Institute, blepharitis is a frequent trigger for dry eyes since blepharitis causes oil and crust to block your tear ducts. “Patients with posterior blepharitis affecting the meibomian glands can get severe and painful dry eyes, which can also affect vision,” Dr Hilal-Campo explains. Blepharitis can also cause your eyes to feel more watery because your tears aren’t functioning normally.

Corneal ulcers

“Though less common, the most serious complication of blepharitis is corneal ulcers,” says Dr. Rapoport. “These are sterile marginal ulcers, meaning they are not infectious, but when there is an epithelial defect (the top layer is eroded from the corneal surface), this invites bacteria in to create an overlying infection. When not treated, corneal ulcers can lead to permanent scarring and vision loss,” Dr. Rapoport warns. 

When to see a healthcare provider

According to the American Optometric Society, most cases of blepharitis are diagnosed during a routine eye exam. But you should visit your optometrist or ophthalmologist if you experience any blepharitis symptoms (e.g., redness, crusting, burning, and itching) for the first time or if your current symptoms aren’t improving after adopting an eyelid hygiene routine.

 Most of the time, blepharitis can be diagnosed on sight, without additional testing. Your provider may also ask you questions about the nature of your symptoms, including when they started, how they progressed, and if you are experiencing any other health-related issues.

Treatment

The main treatment for blepharitis involves keeping the eye and eyelid area clean so bacteria don’t proliferate, and this is something you’ll need to do on a long-term basis. “Because blepharitis is a chronic disease, eyelid hygiene continues after an acute exacerbation to prevent recurrence of symptoms,” explains Dr. Hilal-Campo. In some cases, especially if blepharitis complications emerge, medication may also be necessary to manage the condition.

Blepharitis self-care

Cleaning debris from your eyes and practicing eye hygiene on a regular basis is the mainstay of blepharitis treatment. This may involve:

• Apply warm compresses to the eyelids to soften eye crust and loosen oil from the gland, improving meibomian gland function.
• Lid scrubs are gentle cleansers used to remove bacteria and debris from your eyelids and lashes.

The American Academy of Ophthalmology (AAO) recommends washing your eyelashes with diluted baby shampoo on a daily basis. It also suggests washing your eyebrows, along with your hair and scalp, with antibacterial shampoo as a way to combat blepharitis. The AAO also mentions fish oil supplements, which are a good source of omega-3 fatty acids that might help combat blepharitis.

Blepharitis medication

In some cases, medication may be required for blepharitis.

As the National Library of Medicine explains, both topical (applied to skin) and oral antibiotics can be used. Topical blepharitis antibiotic creams such as bacitracin or erythromycin may be prescribed for acute cases of blepharitis and anterior blepharitis. Macrolide antibiotics or oral tetracyclines may be prescribed for posterior blepharitis.

In cases of severe blepharitis, a healthcare provider may prescribe a topical corticosteroid (anti-inflammatory) or immunosuppressant as a blepharitis treatment. Both reduce inflammation and swelling. Examples include:

• Loteprednol etabonate
• Blephamide, which contains a steroid as well as an antibiotic
• Cyclosporine or tacrolimus, which are immunosuppressants

Finally, eye drops like Systane may help alleviate some of the symptoms of dryness and discomfort.

Prevention

Dr. Wright shares the following tips to prevent blepharitis—or at least minimize its recurrence:

• Practice good eyelid hygiene, which involves regularly cleaning your eyelids and lashes to remove make-up, lid debris, and excess oil.
• Avoid wearing make-up when your blepharitis is flaring.
• Always remove contact lenses when sleeping.
• Manage conditions that may exacerbate blepharitis, such as seborrheic dermatitis.

“While not all cases of blepharitis can be prevented, practicing proper lid hygiene is essential,” says Dr. Giyaur. In many cases, it will help delay or prevent the onset of blepharitis. Don’t hesitate to consult a healthcare provider at the first sign of symptoms. Blepharitis is treatable during the onset of symptoms but is more difficult to treat in later stages.