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What Is Blepharitis?

Blepharitis (pronounced “bleh-fur-eye-tis”) is a condition that causes the eyelids to become red and swollen. This inflammation is caused by an overgrowth of microorganisms and plugged oil glands in the eyelid. It is common with underlying skin conditions such as acne rosacea and seborrheic dermatitis.

While blepharitis is not contagious, it can become chronic (recurring continuously over time). Eventually, blepharitis can also lead to styes and eye infections such as conjunctivitis.

It doesn’t usually cause vision damage, but if left untreated, blepharitis can cause scarring of the cornea. In these advanced situations, it may affect vision.

Types of Blepharitis

There are two types of blepharitis: Anterior and posterior.

Anterior – Develops on the outer eyelid along the lash line. It occurs when the lid of the eye reacts poorly to bacteria and/or dandruff from the eyebrows and face. It may also be caused by allergies or eyelash mites.

Posterior – Affects the inner portion of the eyelid that is behind the lash line and right next to the surface of the eyeball. It develops due to poor oil production from the meibomian glands in the eyelid, which can encourage bacteria and other microorganisms to grow. It may also be caused by rosacea or other skin conditions.

Eyelid inflammation can also be classified as acute or chronic:

  • In acute cases, there is a sudden onset of symptoms that can be treated and cured.
  • In chronic cases, symptoms flare up regularly without constant preventative measures.

Blepharitis vs. Stye

While blepharitis and styes are related, they aren’t the same thing. As mentioned before, blepharitis is inflammation of the eyelid. This inflammation affects all the oil glands of the eyelids and can be seen by an eye doctor with a magnifier they use in the clinic (a slit lamp).

A stye is a bump that develops on the eyelid. When a stye is painful, it is most similar to a pimple and is caused by an infection of one or more oil glands in the eyelid. This is called a hordeolum.

When a stye grows slowly and is not painful, it is caused by a blockage in one of the eyelid’s oil glands. This is called a chalazion.

Sometimes, developing a stye is the first sign that you have blepharitis. Treating blepharitis every day is a way to avoid having styes come back again and again.

Blepharitis Signs and Symptoms

While signs and symptoms may vary, the most common ones associated with blepharitis are:

  • Red, swollen, and tender eyelids
  • Foreign body sensation (feeling like there’s something in your eye)
  • Crusty eyelashes or lids, especially after waking up
  • Dry eyes
  • Watery, stringy, or sticky eye discharge
  • Itchy, red, or watery eyes
  • Light sensitivity
  • Stinging or burning sensation in your eyes
  • Tears that appear to have bubbles in them (“foamy” tears)

Though rare, more serious signs and symptoms may occur, such as:

  • Loss of eyelashes
  • Abnormal direction of eyelash growth
  • Blurry vision
  • Swelling and scarring of the cornea or other parts of the eye
  • The growth of small calcium particles on the inside of the eyelid (concretions)

How Long Does Blepharitis Last?

More often than not, blepharitis will not be completely cured, which is what makes it a chronic condition. People with chronic cases must practice preventative measures for the rest of their lives to avoid flare-ups.

Acute cases, where symptoms are caused by an allergic reaction or a bacterial or viral infection, can be treated. How long the symptoms last depends on:

  • What’s causing the symptoms
  • Whether the patient seeks treatment
  • How well the patient follows their doctor’s recommendations

What Causes Blepharitis?

Eyelid inflammation, both acute and chronic, can be caused by a number of things. After a comprehensive eye exam, your eye doctor should be able to pinpoint the cause of your symptoms and prescribe the best treatment for your case.

Potential causes of anterior blepharitis include:

  • Dandruff flaking associated with seborrheic dermatitis
  • Acne rosacea that can cause eyelid inflammation
  • Eyelash mites or lice
  • Dry eyes
  • Allergies to certain eye drops, contact solutions, or eye makeup

Potential causes of posterior blepharitis include:

  • Problems with oil-producing glands in the eye (meibomian gland dysfunction)
  • Dandruff
  • Acne rosacea

In general, these cases are usually caused by:

  • Poor hygiene
  • Skin conditions like rosacea and dermatitis
  • Allergies
  • Infection
  • Trauma
  • Exposure to certain toxins

Risk Factors

If one or more of the following characteristics applies to you, you may be at a higher risk of developing eyelid inflammation:

  • Wearing contact lenses
  • Having dry eyes
  • Experiencing hormone changes (menopause, pregnancy, etc.)
  • Having oily skin
  • Failing to completely remove your makeup each day
  • Being on certain medications
  • Living in a dry environment
  • Having exposure to chemicals, dust, and other irritants
  • Being diabetic
  • Having a higher-than-usual amount of skin microbes

Blepharitis Treatment

Since most cases of blepharitis do not go away completely, your eye doctor can suggest methods to help keep the symptoms at bay. If you have an acute (one-time) case, they may prescribe a steroid or antibiotic to target the source of your symptoms.

To help manage your symptoms, you should:

Avoid Touching Your Face and Eyes

Because of the amount of bacteria that live on your hands and fingers, it’s a good idea to avoid touching your face — even if you don’t have blepharitis. Touching or rubbing your eyes with dirty hands can transfer that bacteria to different parts of your eyes and open them up to infection.

If you need to touch your face or eyes to apply contact lenses or put on sunscreen, be sure to wash your hands with soap and water first.

Keep Your Eyes, Face, and Hair Clean

If you’re prone to blepharitis flare-ups, it’s important to keep your eyelids and the surrounding areas — like your face and hair — clean. Using warm water and a gentle soap like baby shampoo to wash your eyelashes every day can help reduce your risk of irritation and infection.

For hair care, choose an antibacterial shampoo to use on your scalp and eyebrows. People who have dandruff should use anti-dandruff shampoo to minimize the amount of flaking they experience.

Apply a Warm Compress and Practice Eyelid Massage

Placing a warm compress over your eyes can help loosen any flakes or crust in your eyelashes, which is important to keep the lids of the eye clean. Warm compresses also come in handy for loosening any oil that may be clogging the oil glands in your eyelids.

After the compress has rested on your eyes for at least five minutes, start to gently massage your eyes over the compress. Doing so helps to release oil in the glands and can reduce the risk of them getting clogged. On top of that, it feels really nice and gives you a moment to relax.

Use Antimicrobial Foam and Towelettes

Bacteria and other microorganisms can develop a protective covering on the edge of the eyelid called a biofilm. Treatment with towelettes or special foams that contain tea tree oil or hypochlorous acid can help remove this biofilm as well as slow down bacterial and microbial growth.

Use Eye Drops

Your eye doctor may prescribe eye drops or ointment to use on your eyes. The type of eye drops they prescribe will depend on the cause of your symptoms.

Steroid eye drops can help with inflammation, while antibiotic eye drops help with infection. Your doctor may also suggest over-the-counter eye drops or artificial tears to help with dry eye if that seems to be a contributing factor.

Avoid Eye Makeup

For your comfort and safety, it’s best to avoid makeup on and around the eyes when you’re experiencing a flare-up of symptoms. Putting cosmetics on top of irritated skin may worsen the issue.

When you don’t have symptoms, be sure to follow our tips for applying makeup with contacts. Then be sure to completely remove your makeup before going to bed each night. Doing so not only helps prevent eyelid irritation but saves you from several other eye problems that can result from sleeping in your makeup.

Treat the Underlying Cause

If blepharitis is secondary to an underlying condition such as dermatitis or rosacea, treating the underlying problem can help relieve your blepharitis symptoms.

Sharing your medical history with your eye doctor allows them to look at the whole picture so they can make a proper treatment plan.

In-Office Procedures

Severe cases of blepharitis may prompt your doctor to suggest an in-office procedure to relieve some of your symptoms. These procedures may include:

  • Thermal pulsation – A device that uses heat and massage is placed on your eyelids to release blocked oil glands.
  • Intense pulsed light (IPL) – Light energy is used on your eyelid skin to unblock oil glands, close small blood vessels, kill microorganisms, and improve the appearance of eyelid inflammation.
  • Thermal expression – A machine uses heat and gentle force to encourage oil gland production.
  • Microblepharoexfoliation – Eyelash mites, lice, bacteria, skin flakes, and crusting are exfoliated from the eyelids using a tiny sponge.

If you start to notice signs of blepharitis, see an eye doctor for a comprehensive eye exam. Getting proper assessment and early treatment can help prevent symptoms from worsening and give your eyes a better chance at a clear and comfortable future.