What is blepharitis?
Blepharitis, pronounced bleh-fur-RY-tis, means inflammation of the eyelid. The edges of your lids turn red or dark in color and become swollen and scaly. Blepharitis usually affects both eyes. It can happen when a skin condition causes irritation, when you develop an infection or when oil glands become clogged. All of these things can even happen at once.
Blepharitis is a term for inflammation, but it can lead to an infection in your eye. However, most cases of blepharitis aren’t contagious. They aren’t likely to lead to blindness.
How common is blepharitis?
A survey of ophthalmologists and optometrists reported that nearly half of the people they see showed symptoms of blepharitis. The condition is common and symptoms are manageable.
Blepharitis typically affects adults and children of both sexes equally. However, one form — staphylococcal blepharitis — mainly affects women and people assigned female at birth (AFAB). This is true of about 80% of cases.
Are there different types of blepharitis?
There are two types of blepharitis, depending on where it’s located on your eyelids. They are:
- Anterior blepharitis: This type occurs when your eyelid’s front exterior, where the eyelashes come out of your lids, is red or darker in color and swollen, or when you have dandruff on your lashes.
- Posterior blepharitis: This type happens when the oil-producing meibomian glands under your eyelid produce thickened/unhealthy oil.
Symptoms and Causes
What are the signs and symptoms of blepharitis?
There are several signs and symptoms of blepharitis. They may include:
- Swollen eyelids and/or greasy eyelids.
- Red, irritated eyes that itch or burn.
- Crusting of eyelashes and eyelid corners, making your eyelids stick together.
- Flakes of skin collecting around your eyes and eyelids.
- Dry eye or excessive tearing.
- Excessive blinking.
Other signs and symptoms may include:
- Photophobia (light sensitivity).
- Blurred vision.
- Loss of eyelashes.
- Eyelashes that grow toward your eyes rather than away from them (trichiasis).
What causes blepharitis?
Blepharitis can happen if you have issues with the meibomian glands that produce the oils found in tears, certain skin conditions or infections.
Causes of anterior blepharitis
- Acne rosacea: Rosacea causes facial skin inflammation, which can include your eyelids.
- Allergies: Allergies to contact lens solution, eye drops or makeup can spur irritation.
- ++Dandruff (seborrheic dermatitis): ++Dandruff flaking can irritate eyelids and cause inflammation.
- Dry eyes: Dry tear ducts can alter bacterial resistance, resulting in infection.
- Lice or mites in eyelashes (demodicosis): Lice or Demodex mites can block eyelash follicles and glands in your eye. One study found that 30% of people with chronic blepharitis had Demodex mites.
Causes of posterior blepharitis
- Meibomian gland dysfunction (MGD): When the oil from meibomian glands doesn’t flow freely, you can develop dry eye, which can result in inflammation and infection.
- Acne rosacea.
The symptoms you have may indicate a particular type of blepharitis: staphylococcal, seborrheic, ulcerative or meibomian. For instance:
- Seborrheic blepharitis has symptoms that include greasy flakes.
- Ulcerative blepharitis may cause bleeding when you remove crusts.
- Meibomian blepharitis causes your tears to be of poor quality.
- Staphylococcal blepharitis symptoms may include missing eyelashes or lashes that point the wrong way.
What are other risk factors for developing blepharitis?
In addition to having rosacea and dandruff, you may be more at risk of developing blepharitis if you:
- Have diabetes.
- Wear contact lenses.
- Are exposed to irritants like dust and chemicals.
- Work or live in dry environments. This includes spending a lot of time in air conditioning.
- Have a high number of microbes that normally live on your skin.
- Don’t remove makeup thoroughly.
- Have oily skin.
- Are on certain drugs such as those for cancer treatment.
- Are going through menopause or hormonal changes.
Do poor hygiene habits cause blepharitis?
Poor hygiene can be a factor in blepharitis, but it’s not as simple as saying that only people with poor hygiene can get blepharitis. Hygiene is just a part of the reason that some people get blepharitis.
If you think about it, most people don’t clean their eyelids and lashes every day or night. However, people with risk factors may have to make eyelid and eyelash hygiene a priority.
Diagnosis and Tests
How is blepharitis diagnosed?
There’s no single test for blepharitis. Here are a few steps your eye care provider may take to find out if you have blepharitis and what type it is:
- Take a health history: The provider will ask about symptoms and other health conditions to determine your risk factors.
- Do an external eyelid exam: The appearance of your eyelids and intensity of reddening, discharge and swelling will help determine the type and severity.
- Take cultures of discharge: A swab of eyelid secretion sent to a lab can determine contents, including what type of bacteria is present and in what quantity.
- Do a tear test: A sample of tears can determine if dry eye is a contributing factor.
- Do an eyelash exam: Evaluating eyelashes under a microscope can detect mites.
- Perform an eyelid biopsy: Rarely, your provider may need to do a biopsy to rule out skin cancer or other abnormal cells. Your eye care provider will numb your lid with local anesthetic. Then they’ll use a needle to take a sample of cells to examine under a microscope. You may bruise, but you’re not likely to have a scar.
Management and Treatment
Can I treat my blepharitis at home?
For some types of blepharitis, self-care at home may help soothe the symptoms. If you believe you have blepharitis, try these tips:
- Avoid eye makeup: To lessen irritation, you may want to avoid eye makeup until the inflammation is managed.
- Use warm compresses: Take a clean washcloth and wet it with very warm water. Wring out excess water, and place the cloth over your eyelids. Repeat this as necessary to keep the cloth temperature constant. Eventually, the crusts will dampen and oily debris will be easier to wipe away. Commercially available microwavable heat masks can hold heat longer and may be more effective.
- Get some omega-3s: Some studies have found that omega-3s, found in fish or flax seed oil, will help the glands in your eyes work better. Eating green, leafy vegetables and avoiding high fat foods can also be helpful.
- Lid scrubs: These are available over the counter as a spray, foam or individually wrapped towelettes, often containing hypochlorous acid. They help reduce dandruff on your lashes and the bacterial numbers on your eyelid skin.
Alternatively, you can make your own lid scrubs at home. Follow these steps:
- Use a new clean cloth to wash each eyelid. This will help lessen any bacteria spread from one eye to the other.
- Mix a solution of 50% baby shampoo and 50% water.
- Place the warm, wet washcloth over your index finger and apply the soapy solution to the cloth.
- Close the eye you’re cleansing and rub the washcloth over the lashes and lid margins several times using horizontal strokes.
- Rinse thoroughly with a clean, warm wet washcloth.
- Repeat for your other eye.
If cleaning your eyelids carefully for several days doesn’t get rid of the crusts, you should see an eye care provider.
How will an eye care provider treat my blepharitis?
Your blepharitis treatment will depend upon the type you have. After examining your eyelid swelling and running tests, your provider may prescribe treatments that include some or all of the following.
Antibiotics to treat blepharitis
You may get a prescription for an antibiotic ointment — such as erythromycin, bacitracin ophthalmic or Polysporin® for your eyelid — or for antibiotic eye drops, such as a combination of polymyxin B and trimethoprim (Polytrim®). These treatments may help resolve the bacterial infection and reduce irritation. Cases that persist may require an oral antibiotic, such as doxycycline or azithromycin.
Anti-inflammatories to treat blepharitis
Your provider may add a steroid eye drop or cream to your treatment plan if you need stronger medicine. Steroids reduce inflammation. Your provider may prescribe both antibiotics and anti-inflammatories to treat underlying conditions or secondary infections.
Immunomodulators to treat blepharitis
Adding an immunomodulatory drug, such as cyclosporine ophthalmic (Restasis®) in cases of posterior blepharitis, has been shown to reduce inflammation. These drugs block your body’s natural immune response and therefore reduce inflammation.
Treating blepharitis by treating the root cause
It’s important to treat root causes that trigger blepharitis, in addition to soothing symptoms. Skin conditions (such as rosacea) or eye ailments (such as dry eye) can lead to blepharitis recurring more often. In these cases, certain pills, skin creams, or eye drops for dry eyes may help.
Treating blepharitis with clinical procedures
Your provider can do some newer procedures in their office. These include:
- Lipiflow®, which warms up the lids and expresses the unhealthy oils.
- Intense Pulsed Light therapy, which involves the application of bright red light pulses to your eyelid skin.
- BlephEx®, which involves cleaning your eyelid margins.
What complications can result from blepharitis?
You can’t cure blepharitis. However, it can be treated and controlled through proper eyelid hygiene. Left untreated, blepharitis may lead to other more serious eye conditions, including corneal problems, which may be significant.
- Chalazion: A chalazion is a small, painless eyelid bump/swelling.
- Corneal ulcer (keratitis): A sore on your cornea can result from prolonged infection or eyelid swelling.
- Eyelid issues: Eyelashes may shed, grow in odd directions or lighten because of chronic blepharitis.
- Pink eye (conjunctivitis): Some types of blepharitis may turn into chronic pink eye.
- Sty (stye): A sty (stye) is a red, painful eyelid bump near your eyelashes.
- Tear film issues: Tears exist in a delicate balance of mucus, oil and water to keep your eyes moist and protected. If skin or oily debris accumulates and causes irritation, you can develop dry eyes or excessive tearing. Healthy oils secreted by the eyelid margin help protect the tears from evaporating. Dry eye can get worse when blepharitis causes you to excrete unhealthy oils.
How do I prevent blepharitis?
Many blepharitis cases aren’t preventable. Some risk factors for blepharitis, such as certain skin conditions, are beyond your control. Here are some steps you can take every day to help with the symptoms:
- Keep your hands, face and scalp clean.
- Try not to touch your itchy eyes or your face. Use a clean tissue if you must touch them.
- Remove all eye makeup before bedtime.
- Wipe away excess tears or eye drops with a clean tissue.
- Wear glasses instead of contact lenses until the condition clears.
- Use artificial tears if you have dry eyes and your provider agrees.
- Use anti-dandruff shampoo to wash your hair.
- Replace eye makeup — eyeliner, eye shadow, mascara — because they may have bacteria in the containers. You want to avoid reinfection.
A note from Cleveland Clinic
Blepharitis, with its symptoms of swollen, red, itchy eyelids, is never fun. However, in most cases, blepharitis is a condition that you can manage. If you can treat any underlying issues, and you practice good eyelid hygiene, you’ll likely have fewer flare-ups.
What is the main treatment of blepharitis? ›
Antibiotics applied to the eyelid have been shown to provide relief of symptoms and resolve bacterial infection of the eyelids. These are available in several forms, including eyedrops, creams and ointments. If you don't respond to topical antibiotics, your doctor might suggest an oral antibiotic.How do you get rid of blepharitis fast? ›
Home remedies include:
- Putting a warm compress over your eyes – gently.
- Cleaning your eyelids regularly.
- Massaging your eyelid.
- Avoiding eye makeup when you have a flare-up.
- Not wearing contact lenses.
Most of the time, blepharitis happens because you have too much bacteria on your eyelids at the base of your eyelashes. Having bacteria on your skin is normal, but too much bacteria can cause problems. You can also get blepharitis if the oil glands in your eyelids get clogged or irritated.What is the best eye drops for blepharitis? ›
- Use 1 drop in each eye 2-4 times daily, each and every day.
- Using your drops regularly is far more important than using any particular brand of drops. However, some over-the-counter brands that you might try include Systane, Refresh, Blink, and Soothe.
Reduce consumption of wheat, flour and sugar. Limit alcohol intake. Avoid foods rich in fructose, cream, butter and margarine (saturated fats!)What deficiency causes blepharitis? ›
Other dermatological manifestations of vitamin A deficiency include blepharitis , noted in our first patient, and cheilitis.Are there eye drops for blepharitis? ›
Many cases of blepharitis are treated with topical antibiotic ointment or eye drops such as erythromycin or bacitracin. Topical antibiotics both reduce bacteria on the eyelid and significantly relieve symptoms.How do you wash your eyes with blepharitis? ›
- Put a few drops of baby shampoo in a cup of water, and dip a cotton ball, cotton swab, or washcloth in the liquid. With your eyes closed, gently wipe across each eyelid about 10 times. ...
- Or, if you take a shower, let warm water run over your closed eyes for a minute.
Neosporin is a combination antibiotic that treats conjunctivitis, keratitis, and blepharitis in adults.Can stress cause blepharitis? ›
However, when there is a build up of the staph bacteria around the eyelids or when the immune system is under stress, blepharitis can result.
What autoimmune diseases cause blepharitis? ›
Blepharitis can be part of the symptoms of seborrheic dermatitis or a highly reactive form of acne known as rosacea. A combination of blepharitis and dry mouth may indicate an autoimmune condition known as Sjogren's (SHOW-grins) syndrome.What viruses cause blepharitis? ›
Acute ulcerative blepharitis is caused by a bacterial infection, usually staphylococcal. It can also be caused by a virus, like herpes simplex or varicella-zoster. Acute nonulcerative blepharitis is usually caused by an allergic reaction.What ointment is good for blepharitis? ›
Topical antibiotics should be used in all cases of acute blepharitis and cases of anterior blepharitis. They have been found to be useful in symptomatic relief and eradicating bacteria from the lid margin. Topical antibiotic creams like bacitracin or erythromycin can be applied to the lid margin for 2 to 8 weeks.What can an ophthalmologist do for blepharitis? ›
For people with severe cases of blepharitis, Columbia ophthalmologists might prescribe antibiotic medications or steroid eyedrops. For people who also have scalp dandruff, the doctor might recommend a dandruff shampoo to help with treatment. People who also have acne rosacea should have that condition treated as well.What oral antibiotic is good for blepharitis? ›
Oral tetracycline or doxycycline may be effective for people with posterior blepharitis or symptoms not adequately controlled by lid hygiene and topical medications, especially those with concurrent MGD (AAO 2018).Can vitamin D deficiency cause blepharitis? ›
Vitamin D deficiency may also be linked to an increased risk of MGD and, by extension, an increased risk of blepharitis. In a 2021 Japanese study , researchers found increased MGD prevalence among people with lower intake of: vitamin D.Does blepharitis get worse with age? ›
Other causes include poor eyelid hygiene, bacterial infections, or allergic reactions. Blepharitis can begin at any age and gets worse with aging, so it's important to identify and treat it.What vitamin deficiency causes dry eyelids? ›
Vitamin D deficiency can cause dry eye symptoms. A study found that patients with dry eye disease had significantly lower vitamin D levels. In a study, Vitamin D supplements helped with immune function by reducing eye inflammation, promoting tear secretion, and improving tear quality.How do I stop blepharitis from coming back? ›
- Keep your eyelids clean.
- Remove all eye makeup before bed.
- Don't use eyeliner on the back edges of your eyelids, behind the lashes.
- If you're in the early stages of treating blepharitis, prevent further irritation by not using makeup.
The most common bacteria in chronic blepharitis include Staphylococci, Corynebacterium, and Propronibacterium species (Dougherty and McCulley, 1984; Teweldemedhin et al., 2017).
What foods should I avoid with dry eyes? ›
- Alcoholic Beverages. Alcohol is one of the most guilty culprits behind dry eyes. ...
- High-Sodium Snacks. ...
- High-Sugar Foods. ...
- Find Dry Eye Relief with the Right Champaign Eye Doctor.
specifically for Blepharitis would be Systane Balalnce or Optive Plus used four times a day with Systane Gel (thicker) at night time. They can help lubricate the eye and dilute the slightly acidic tears due to the Blepharitis.Why won't my blepharitis go away? ›
Many patients struggle with itchy, inflamed, crusty eyelids that no matter how much they perform lid scrubs or warm compresses will not resolve. The problem is often associated with a parasitic mite called Demodex that infests the eyelashes.Can I use Cetaphil on my eyelids? ›
You can wash your whole face or entire body with Cetaphil. Because it is so gentle and hypoallergenic, it can be used once or many times daily without stinging, drying, or cracking the thin delicate skin of the eyelids.Is heat or cold better for blepharitis? ›
To treat the problem, keep your eyelids clean. Warm compresses can reduce redness and swelling, and help clean your eyelids, too. You may also need to wash the area gently with an eyelid scrub when you wake up.How do you disinfect your eyelids? ›
Use a prepared lid scrub solution advised by your optometrist or a mixture of warm water and a tiny bit of non-irritating shampoo ( such as baby shampoo). Close one eye and wipe the solution back and forth across the eyelashes and the edge of the eyelid with a clean washcloth (a separate one for each eye).What ointment is safe for eyelids? ›
Neosporin ophthalmic ointment can treat blepharitis, inflammation of the eyelids. Blepharitis symptoms include the following: Redness of the eyelids. Swelling of the eyelids.Is there an over-the-counter antibiotic eye ointment? ›
All antibiotic eyedrops and ointments require a prescription from a provider. Polysporin (bacitracin / polymyxin B), the topical ointment with the same ingredients used for preventing skin, is available over-the-counter.How serious is blepharitis? ›
Blepharitis causes swollen, itchy eyelids. It's not usually serious and can often be treated by washing your eyelids every day.Is blepharitis always caused by mites? ›
Blepharitis typically occurs as a result of a blockage in the oil glands at the base of the eyelashes, sometimes as a result of a demodex mite infestation. Demodex mites become more prevalent with age, and are typically the cause of blepharitis in patients over the age of 60.
Is blepharitis a symptom of lupus? ›
Blepharitis is a rare involvement of the chronic lupus erythematosus and in case that is isolated, the diagnosis is belated and can lead to complications. The involvement of the lower eyelids is more frequently especially theirs lateral third.What systemic diseases cause blepharitis? ›
Blepharitis often is associated with systemic diseases, such as rosacea, atopy, and seborrheic dermatitis, as well as ocular diseases, such as dry eye syndromes, chalazion, trichiasis, ectropion and entropion, infectious or other inflammatory conjunctivitis, and keratitis.What conditions are similar to blepharitis? ›
- Blepharitis. One of the most common eyelid problems is blepharitis, or inflammation of the eyelid margin. ...
- Meibomianitis. ...
- Lacrimal duct obstruction. ...
- Chalazion. ...
- Stye/hordeolum. ...
- Blepharospasm. ...
- Blepharoptosis. ...
- Anterior: Found on the outside of the eyelid, including the area where your eyelashes attach.
- Posterior: Found on the inside of the eyelid, next to your eyeball, and tied to problems with oil (meibomian) glands.
Blepharitis is defined as inflammation of the eyelids, and infectious blepharitis may occur secondary to bacterial, viral, fungal, or parasitic infection.What preservative free eye drops for blepharitis? ›
Severe dry eye: use preservative free drops such as Bion Tears, Theratears drops, Cellufresh, Blink, Optive Sensitive, or thicker drops such as Theratears liquid gel, Polygel, Celluvisc at least 4 times a day, in addition to a night time ointment such as Ircal or Lacrilube.How do you reduce eye inflammation? ›
Medicines called steroids can reduce inflammation in your eye. This can ease symptoms and prevent vision loss. Your eye doctor may prescribe steroids in a few different ways: Eye drops.How do I reduce eyelid swelling from blepharitis? ›
- Warm moist compresses such as washcloths or microwaveable heat masks, or electronic compresses, can be applied to the eyelids and eyelashes with eyes closed for 10 minutes.
- Follow that with a gentle cleaning of the eyelids and eyelashes with eyes closed for 30 seconds.
Oral tetracycline or doxycycline may be effective for people with posterior blepharitis or symptoms not adequately controlled by lid hygiene and topical medications, especially those with concurrent MGD (AAO 2018).How long does blepharitis take to clear up? ›
How long does blepharitis take to clear up? Blepharitis has several causes, so some cases may take longer to resolve than others. Most treatments for acute blepharitis last for four to six weeks.
How do you unblock oil glands in your eyes? ›
Heating the eyelid margin will increase oil production and melt the “crusty” oil that has become solid in the glands. Use a warm (not too hot) wet washcloth to apply heat on the eyelids for four minutes or more. This warms the oil, allowing it to flow more freely, and helps soften lash debris.Does wearing glasses help blepharitis? ›
By keeping out irritants, moisture chamber glasses can help you avoid a more serious episode of blepharitis. Moisture chamber glasses are a valuable tool for blepharitis sufferers.What infection causes blepharitis? ›
Anterior blepharitis is commonly caused by bacteria (staphylococcus) or oily build-up (seborrhea) associated with skin conditions like rosacea. Posterior blepharitis can worsen dry eye and lead to painful eyelid styes.How do you reduce inflammation of blepharitis? ›
Things you can do to treat and prevent blepharitis
Gently massage your eyelids for around 30 seconds. Clean your eyelids using cotton wool or a cotton bud. It might help to use a small amount of baby shampoo in water. Gently wipe along the edge of your eyelids to remove any flakes or crusts.
While blepharitis does not usually go away and there is no cure, the condition is easily maintained by practicing regular eyelid hygiene. It is important for patients to know that left untreated, blepharitis can lead to worse infections and further complications.Does blepharitis worsen with age? ›
Other causes include poor eyelid hygiene, bacterial infections, or allergic reactions. Blepharitis can begin at any age and gets worse with aging, so it's important to identify and treat it.Can too much screen time cause blepharitis? ›
Those that stare at a computer screen for large periods of time throughout the day are also more prone to blepharitis, especially when sitting in an air-conditioned room or office. This is why eye exams that are comprehensive are important to help reduce the chances of Blepharitis before it worsens.Can blepharitis be caused by stress? ›
Hormones, nutrition, general physical condition, and even stress may contribute to seborrheic blepharitis.