Blepharitis

What is blepharitis?

This is an image of a person with blepharitis causing redness and swelling of the eyelid.

Blepharitis is a common eye condition where the edge of the eyelid (eyelid margins) becomes inflamed, swollen and red. In most cases both eyes are affected but one may be worse than the other and symptoms tend to be worse in the morning. The condition can develop at any age and is not contagious but is often a long –term condition. Symptoms often include:

Crusty or greasy eyelashes
Sensitivity to light
Finding it difficult and uncomfortable to wear contact lenses
Itchy, sore and red eyelids that may stick together
A burning sensation in your eyes
Swollen eyelid margins
Abnormal eyelash growth or loss of eyelashes
Watery eyes
Infection of the eyelash follicle or sebaceous gland (hordeolum)
Frequent blinking

Cataracts aren’t painful and won’t irritate your eyes or make them red.

Types of blepharitis

There are three types of blepharitis;

Anterior blepharitis – where the skin around the base of your eyelashes becomes inflamed
Posterior blepharitis – where Meibomian glands, found along the eyelid margins behind the base of the eyelashes are inflamed
Mixed blepharitis – a combination of both anterior and posterior blepharitis

What causes blepharitis?

Anterior blepharitis can be caused by seborrhoeic dermatitis, a skin condition which means the skin can become oily or flaky and cause bad dandruff (usually in the upper body and face), which can then block the Meibomian glands. The underlying cause of seborrhoeic dermatitis is not known but a type of yeast called Malassezia furfur is thought to be connected. This yeast lives in the oil of human skin in most adults and usually does no harm. But, in some people the yeast can trigger a reaction, causing the blepharitis.

Anterior blepharitis can also be caused by a reaction to Staphylococcus bacteria which are found naturally in low numbers on the skin of most people and are generally harmless. However, some people can have a reaction to them causing the eyelid to become inflamed.

Posterior blepharitis is caused by skin flakes, dirt or inflammation causes the Meibomian glands to become blocked, causing irritation. Sometimes the Meibomian glands can become blocked due to skin conditions like rosacea as the skin over produces oils. Some people also have a problem with the amount of fluid produced by these glands which can lead to blepharitis.

Mixed blepharitis is the most common and is a combination of both anterior and posterior blepharitis, meaning it is caused by a mixture of the issues above.

How to treat blepharitis

Blepharitis can’t usually be cured but a daily cleaning routine for your eyelids can help reduce the symptoms and prevent permanent scarring of the eyelid margins. There are 3 main steps which should be carried out twice a day:

Using a warm compress which makes the oils easier to remove
Massaging the eyes, this helps push the oil out of the Meibomian glands
Cleaning away any oil, dirt or skin flakes from your eyelids which may have built up

More serious cases may require antibiotics either taken as tablets or applied to the eye/eyelid directly for around 4-6 weeks as directed by your GP or optician.

Warm compress

Boil some water and leave to cool until it is warm but not too hot
Place a clean flannel or eye pad in the water and place on the eyes for about 10 minutes
Keep the compress warm by putting it back in the warm water if it cools down

A special microwaveable compress or small hot water bottle may be used but make sure to clean them thoroughly before and after each use to avoid making symptoms worse.

Eyelid massage

Gently massage closed eyes with your fingertips in circular motions
With your eyes shut roll a cotton bud gently down your upper eyelid towards your lashes. This helps push the oil out of your glands but you won’t be able to see the droplets because they are very small
Repeat this along the entire upper and lower eyelids. This may irritate your eyes a bit at first but should get better with time

Eye hygiene

You can buy cleaning wipes and cleaning solutions for your eyes in pharmacies or you can use a homemade solution (1 pint cooled boiled water to 1 teaspoon of bicarbonate of soda) with cotton pads.

Using a solution with a cotton pad or wipes gently remove any debris or crustiness from your eyes, paying particular attention to your eyelashes. Repeat as necessary until any dirt appears to be removed. Using a cotton bud dipped in solution gently clean along the edge of your eyelid and the bases of your lashes.

You may find some solutions don’t work as well for you as others so it’s a good idea to experiment until you find one that suits you, your GP or optician may be able to advise you on this. Clean your eyes this way 2-3 times a week to prevent flare ups with less thorough cleaning in between as advised by your GP or optician.

Other conditions contributing to blepharitis

If you have other conditions which may contribute to your blepharitis your GP may recommend treatment for those alongside other treatments. For example some skin conditions may need special treatments to calm the symptoms which may then help prevent blepharitis flare ups, or if you have dry eye syndrome eye drops may help ease the discomfort and reduce irritation.

Blepharitis complications

Usually blepharitis isn’t serious but it can lead to a number of further problems. Some people with blepharitis also develop dry eye syndrome, where the eyes dry out quickly and don’t produce enough tears causing your eyes to feel dry and uncomfortable. More serious and sight threatening problems are rare, especially if any problems are identified quickly through regular appointments with your optician and/or GP.

Other complications may include:

Chalazion (meibomian cyst) is a painless swelling, on the inside of the eyelid due to a blocked meibomian gland. This can easily be treated but may become infected and painful
A stye is a painful infected swelling on the outside of the eyelid due to an infection of the follicle of an eyelash
In severe or long-term cases changes to your eyelashes may occur such as loss of eyelashes (madarosis), misdirection of eyelashes towards the eye (trichiasis) or loss of the colour of the eyelashes (poliosis)
Conjunctivitis or inflammation of the front of the eye which may cause a sore, red eye with discharge or watering
Conjunctival phlyctenules which are small (1-3 mm) white lumps (nodules) on the lower part of the eye. They are made of white blood cells in response to bacterial infection - such as staphylococcus
In rare cases inflammation of the cornea (keratitis), ulceration, and scarring can happen. This is serious as it can affect sight. See a doctor or optician quickly if you develop eye pain or any loss of vision from the affected eye

Blepharitis prevention

Blepharitis cannot be prevented as it is often related to underlying skin conditions or defective Meibomian glands. However flare ups can be prevented or reduced easily by maintaining good eye hygiene, removing any make up before bed, regularly replacing make up products used on the eyes- particularly after a flare up, and not using make up during a flare up.

There is some evidence to suggest that diet can affect blepharitis and that a diet high in omega-3 fats can help improve symptoms. Foods high in omega-3 include:

Oily fish such as mackerel, salmon, sardines, herring and fresh or frozen tuna
Some vegetables, nuts and seeds such as chia seeds, soya products, vegetable oils and green leafy vegetables

You can discuss diet choices high in omega-3 with your GP if you need further advice.

Blepharitis FAQs

Can you catch blepharitis?

Blepharitis is not contagious and only affects the patient with the condition.
Is blepharitis permanent?

Blepharitis is not currently curable and is generally a long-term condition, but it can be effectively managed with treatment and good eye hygiene.
Is blepharitis a type of eczema?

Blepharitis can be connected with eczema along with other skin conditions as it can contribute to the amount of oil, dirt and skin flakes which can then clog the Meibomian glands.