Blepharitis: Symptoms, Causes & Treatment

Blepharitis is a chronic eye condition that can cause painful and bothersome symptoms.

Understanding how to spot the signs of blepharitis will help you to determine if and when to speak with a healthcare provider for diagnosis and treatment. 

In this article, I’ll explain the symptoms and causes of blepharitis, how the condition is diagnosed, how to prevent it, and which treatments will help relieve your symptoms.

If you’re experiencing symptoms of blepharitis for the first time, reach out to your eye doctor or healthcare provider for more information.

What is Blepharitis?

Blepharitis is an inflammation of the eye lids due to a blockage of oil glands.

It causes some uncomfortable symptoms, including eyelids that feel swollen, irritated, and itchy.

Though the symptoms can be bothersome, the condition is not contagious.

In some cases, ongoing treatment may be needed to prevent symptoms from recurring. 

How common is it?

Blepharitis is a common eye condition that can affect people of all ages, ethnicities, and genders.

However, the condition is more common in individuals over the age of 50 and in women. 

Though the exact number of cases in the US at any one time is unknown, a 2009 survey revealed that 37% of people seen by an ophthalmologist and 47% of those seen by an optometrist had symptoms of blepharitis.

Another study covering a ten-year period in South Korea suggests that the overall incidence of the condition is 1.1 per 100 person-years and that the overall prevalence for people over 40 years old was 8.8%.

Types of Blepharitis

There are two types of blepharitis.

Though you may have one type of the condition, it’s also possible for you to have both types at the same time:

• Anterior blepharitis: This type affects the outside of the eye, where the eyelashes attach to the eyelid. Common causes of anterior blepharitis are blocked oil glands, bacteria on the skin or dandruff from the scalp or eyebrows. Rarely, allergies and mites can also cause anterior blepharitis.

• Posterior blepharitis: This type affects the outside of the inner edge of the eyelid that touches the eye. Common causes of posterior blepharitis include conditions like oily skin, rosacea, and scalp dandruff.

Symptoms

The most common symptoms of blepharitis are eyelids that feel or appear red, swollen, irritated, or itchy.

Blepharitis can also cause dandruff-like flakes on the eyelashes. 

Additional symptoms of blepharitis can include:

• The sensation that something is in your eye
• Burning or stinging eyes
• Watery eyes
• Sensitivity to light
• Tears that are foamy or have small bubbles in them
• Dry eyes
• Crusty eyelids or eyelashes, often in the morning
• Scales that stick to the base of eyelashes

When present, these symptoms tend to affect both eyes.

In some more severe cases, blepharitis can also result in:

• Blurred vision
• Eyelashes that fall out
• Eyelashes that grow in the wrong direction
• Swelling of the cornea or other parts of the eye

Causes

The exact cause of blepharitis is unknown, but experts believe there to be several possible causes of the condition, including:

• An overgrowth of bacteria
• Clogged or irritated oil glands along the edges of eyelids
• Parasitic infestations with Demodex mites
• Inflammatory skin conditions

A viral infection of Herpes simplex or Varicella zoster is also a possible cause of acute ulcerative blepharitis.

Who is at risk?

Blepharitis can affect anyone, but it’s more likely to affect people with:

• Seborrhea or seborrheic dermatitis: A skin condition that affects the scalp, eyebrows, eyelids, skin behind the ears, and creases of the nose.

• Rosacea: A skin condition that causes a red rash on the face.

• Oily skin: People with oily skin are more at risk of blepharitis caused by clogged or irritated oil glands in the eyelids. 

• Dandruff: A condition which causes flaky patches of skin on the scalp and/or face.

• Allergies: People with allergies that affect the eyelashes are also more at risk of developing blepharitis.

Diagnosis

Thankfully, the diagnosis of blepharitis is often straightforward and non-invasive.

Your eye doctor or primary care provider will likely perform a physical examination of your eyes, eyelids, and eyelashes and ask about your symptoms and medical history.

They may use a bright light or magnifying tool during the physical examination or choose to take special photos of the glands that produce oil for the eyelids.

Treatment

Gently cleaning your eyelids is the best and most effective way to remove excess bacteria and oil and treat most cases of blepharitis.

To clean the eyelids, your provider will recommend using water and a gentle cleanser to clean your eyelids and remove any flakes, scales, or crusts once or twice daily

To clean your eyelids, you should:

1. Wash your hands thoroughly with soap and water 
2. Mix warm water with a gentle cleanser, like baby shampoo 
3. Use a clean washcloth or cotton swab to dip into the warm water and cleanser
4. Gently apply the washcloth or swab onto your closed eye for a few minutes
5. Gently rub the washcloth or swab in a back and forth motion over the area where your eyelashes meet your eyelids
6. Be sure to rinse your eye with clean water afterward
7. Repeat the process on the other eye with a new washcloth or swab

Your provider may recommend additional treatment options to help keep the eyes clean, including:

Warm compress

When symptoms are particularly severe, your provider may recommend using a warm compress on your eyes two to four times daily.

This will help to soften eyelid debris, oils, and dilate eyelid glands, relieving any blockage.

After using a warm compress on the area, it’s important to clean the eyes using the steps listed above.

Be sure to wash your hands thoroughly with soap and water before every application.

Eye drops

If your symptoms are causing inflammation of the eyes, or if cleaning the eyelids daily fails to resolve symptoms, your doctor may prescribe steroid eye drops.

These can help to reduce inflammation as well as redness and irritation.

Your doctor may also recommend using artificial tear drops on the eyes.

Trials have shown that when combined with topical antibiotics, steroid eye drops can produce significant improvement in symptoms.

Antibiotics

If your doctor identifies an overgrowth of bacteria as the cause of your blepharitis they will prescribe a topical antibiotic cream, antibiotic eye drops (like AzaSite or doxycycline ), or antibiotic pills.

According to a recently updated clinical database, topical antibiotics should be used in all cases of acute blepharitis when there is suspicion for bacterial infection.

Good hygiene

Practicing good hygiene and keeping the eyes clean is key to preventing symptoms from recurring.

Eye makeup should be worn sparingly and all possible triggers (allergies, etc.) should be avoided.

Cleaning your eyes and practicing good hygiene should be maintained for the rest of your life in order to keep the condition under control.

Potential Complications

In some cases, blepharitis can lead to other complications:

• Stye: A stye, also called hordeolum, is a red, pimple-like bump that appears on the eyelash line of the eyelid. Unlike blepharitis, which is often a chronic condition, a stye typically lasts a few days to one week.

• Chalazion: A hard bump that can form on the eyelid when a stye doesn’t go away. In most cases, a chalazion goes away on its own over time.

• Dry eye: When oil and fakes build up in the thin layer of tears across the surface of your eye, it can make your eyes feel dry. In other cases, this buildup can make your eyes feel more watery or teary than usual.

• Cornea damage: In rare but severe cases of swelling or irritation of the eye, damage to the cornea can occur. Cornea damage can also occur as a result of eyelashes that grow in the wrong direction.

• Chronic red eye: Chronic red eye can also occur as a result of blepharitis.

Prevention

Practicing good hygiene, cleaning your eyes and face, and treating any acute or chronic skin conditions can help to reduce your risk of developing blepharitis.

However, if you’re already experiencing symptoms of blepharitis, it’s a good idea to reach out to a provider or optometrist to discuss diagnosis and treatment options.

Getting diagnosed is the first step in resolving your symptoms and taking care of your eyes and skin. 

Keep in mind that people who fail treatment for chronic blepharitis should see their provider for a biopsy of the lid to exclude diagnosis of carcinoma, especially when experiencing eyelash loss.

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