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Blepharitis: Causes, symptoms and treatment

What is blepharitis?

Blepharitis is eyelid inflammation that causes red, swollen eyelids and crusty eyelashes. The condition can be difficult to treat and tends to recur. For this reason, it's also known as chronic blepharitis.

Blepharitis is very common. One survey of U.S. eye doctors showed that between 37% and 47% of patients had some degree of eyelid inflammation.

Blepharitis is not contagious and usually doesn't cause serious harm to your eyes or vision, but it can feel unsightly and uncomfortable.

Causes

Blepharitis can be caused by:

  • Bacterial eyelid infection

  • Meibomian gland dysfunction

  • Dry eyes

  • Fungal eyelid infection

  • Parasites (eyelash mites or eyelash lice)

  • Seborrheic dermatitis (dandruff of the scalp and eyebrows)

Blepharitis is usually associated with an overgrowth of bacteria that live along the edge of each eyelid and base of each eyelash.

Over time, these bacteria multiply and create a structure called a biofilm. This biofilm becomes a toxic environment, much like the plaque that forms on your teeth.

Eyelash mites called Demodex feed on the biofilm, leading to an overgrowth of mites. This makes eyelid inflammation worse.

Bacteria in the biofilm also produce substances called exotoxins that cause inflammation of the tiny glands that secrete oil into your tears. This leads to a condition called meibomian gland dysfunction that causes and worsens dry eye discomfort.

Blepharitis is also associated with skin conditions, such as ocular rosacea, eczema, dandruff and psoriasis.

Symptoms

The most common symptoms of blepharitis are:

  • Red, swollen eyelids

  • Crusty debris at the base of the eyelashes

  • Red, burning or stinging eyes

  • Itchy eyes and eyelids

  • Watery eyes

  • Sensitivity to light

  • Grittiness or a feeling that something is in your eye

  • Intermittent blurry vision that typically improves with frequent blinking

SEE RELATED: How to relieve eyelid pain

Conditions associated with blepharitis

If you have chronic blepharitis, you may also have one or more associated conditions or complications, including:

  • Stye – An eyelid stye is a bacterial infection at the base of an eyelash or inside an oil-producing gland in the eyelid. A stye causes a painful red bump at the edge of an eyelid.

  • Chalazion – A chalazion is a clogged oil gland in an eyelid that may begin as a stye. It causes a red, swollen bump on the eyelid.

  • Dry eye syndrome – Clogging of the oil glands in the eyelid can cause the tear film to evaporate quickly, leading to dry eye problems.

  • Eyelash problems – Chronic blepharitis can cause scarring of the lid margin that leads to misdirected eyelashes, or even eyelash loss.

  • Cornea problems – If blepharitis causes eyelashes to grow toward your eyes, the misdirected lashes can rub against the clear front surface of the eye, leading to a painful corneal abrasion. This can also increase your risk of eye infections.

  • Pink eye – Chronic blepharitis can also cause episodes of bacterial pink eye, a form of conjunctivitis. When blepharitis and pink eye happen together, it's called blepharoconjunctivitis.

Blepharitis is also a common cause of contact lens discomfort, forcing many people to give up wearing contacts.

SEE RELATED: Pink eye vs. stye

Treatment

Blepharitis treatment should begin with an eye doctor visit to determine the cause of your eyelid inflammation.

Your doctor will examine your eyes and eyelids to determine whether you have the condition and decide which treatment is best.

Blepharitis treatment can include:

Eyelid scrubs

Gently scrubbing your eyelids removes the buildup of biofilm and excess bacteria from your lid margins. Your eye doctor will typically recommend a daily regimen of warm compresses and lid scrubs to clean your eyelids and reduce the amount of bacteria and mites on your lids.

Cleaning agents can include prescription eyelid cleansers, non-prescription eyelid wipes or diluted baby shampoo.

In-office procedures

While at-home eyelid scrubs are helpful, in-office eyelid hygiene procedures are often recommended for a more effective treatment of blepharitis.

Procedures can include:

  1. Electromechanical lid margin debridement (such as BlephEx treatment) to remove bacteria, biofilm and mites from your eyelids and open clogged oil glands.

  2. Thermal pulsation treatment (Lipiflow, for example) to melt and express any material obstructing the oil glands.

  3. Intense pulsed light (IPL) therapy to open clogged eyelid glands and resume normal flow of oils into the tear film.

Medicated eye drops and/or ointments

Your doctor may also prescribe topical medicines to destroy excess blepharitis-causing bacteria or other microbes on the eyelids — particularly if it appears you have pink eye or some other type of eye infection as well.

SEE ALSO: The fastest way to heal a swollen eyelid

Eyelid hygiene tips

Eyelid hygiene is very helpful to treat, control and prevent blepharitis.

To begin, use a clean, warm compress to melt any blocked residue in your eyelids' oil glands.

Follow these steps:

  1. Wash your hands, then dampen a clean washcloth with warm (almost hot) water.

  2. Place the washcloth over your closed eyelids for several minutes.

  3. Gently rub the edges of your eyelids with the washcloth before opening your eyes — but don't press hard on your eyes.

Follow your eye doctor's recommendations regarding how often to use a warm compress and how long to keep it in place.

When you first start treatment, you could be instructed to do this several times a day, for about five minutes each time. Later on, you might only need to apply the compress once daily.

How to clean your eyelids

Use a cotton-tipped swab to apply cleaning solution recommended by your eye doctor. Rub gently around the edges of your upper and lower eyelids, but do not get cleaning solution in your eye.

The goal of blepharitis treatment is to return your eyelids to a normal, healthy state.

Cleaning your eyelids is an important step toward preventing blepharitis.

Your doctor will recommend what to use for the cleaning agent. Options include warm water, diluted baby shampoo, or an eyelid cleanser. Cleansers can be over-the-counter or prescription.

To clean your eyelids:

  1. Wash your hands.

  2. Moisten a clean washcloth, cotton swab or gauze pad with the cleaning solution.

  3. Gently wipe your eyelashes and lid margin.

  4. Rinse with warm water.

  5. Repeat the process for your other eye, using a different washcloth, swab or pad.

Your eye doctor may have you clean your eyelids several times daily to start, then eventually just once a day.

It's a good idea to limit how often you apply eye makeup when you have blepharitis, since mascara and other makeup can interfere with eyelid hygiene.

If your doctor recommends an anti-dandruff shampoo for your scalp and eyebrows, make sure you keep the shampoo out of your eyes to avoid irritation.

How to prevent blepharitis

Blepharitis is usually a chronic condition, which means it can come back often.

The best way to prevent blepharitis or keep it from coming back is to clean your eyelids daily to stop the buildup of bacteria, biofilm and mites on the eyelid.

A number of non-prescription lid scrub products are available and you can use the same eyelid hygiene techniques described above. There are several prescription eyelid cleansing products that may be more effective than baby shampoo or over-the-counter products.

Your doctor might also recommend nutritional supplements like omega-3 fatty acids to help keep your meibomian glands healthy, and your eyes moist and comfortable.

If you wear contacts or glasses

If you develop blepharitis while wearing contact lenses, discontinue wearing your contacts until the blepharitis has been successfully treated.

Wearing contacts with eyelid inflammation can result in bacteria and other debris sticking to your lenses and causing pink eye or other potentially serious eye diseases.

If you don't currently have a backup pair of glasses, see your eye doctor for an exam to update your eyeglass prescription.

If you are sensitive to light like many with dry eyes, consider glasses with photochromic lenses. These lenses have a special coating that automatically darkens in sunlight and lightens indoors.

After your blepharitis has been successfully treated, you can resume wearing contacts if you want to.

If you currently wear reusable contact lenses, consider switching to daily disposable contacts or gas permeable contacts, which may have a lower risk of blepharitis-related problems.

READ MORE: Swollen Eyelid FAQs

Blepharitis in the United States 2009: A survey-based perspective on prevalence and treatment. The Ocular Surface. April 2009.

Blepharitis. National Eye Institute. Updated August 2020.

What is blepharitis? American Academy of Ophthalmology. December 2020.

Treating blepharitis: Self-care. UC San Diego Health. March 2018.

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