What is Blepharitis?
Your eyelashes have hair follicles that contain oil glands. When these glands become clogged or irritated due to some kind of infection, it triggers inflammation. This is known as blepharitis, or, in simple terms, eyelid inflammation.
This eye condition is relatively common and characterized by noticeable redness and swelling, particularly along the edges where the eyelashes are attached to the eyelids.
According to the American Optometric Association, there are two types of eyelid inflammation – anterior and posterior.
Anterior blepharitis affects the base of the eyelashes on the outside and front edge of the eyelid. Posterior blepharitis, on the other hand, occurs on the inner corners of the eyes, where the eyelid meets the eyeball.
The most prevalent form of blepharitis, however, is a mix of both anterior and posterior blepharitis.
Blepharitis is generally chronic in nature, which means that the condition persists for a long time with repeated flare-up episodes and periods of remission in between.
Although the condition is still largely without a permanent cure, the symptoms can be effectively managed and controlled with a proper eye hygiene routine. Keeping your eyelids clean on a regular basis is key in preventing any form of scarring or injury to the affected area due to prolonged blepharitis.
Nevertheless, you can take comfort in the fact that despite being rather unsightly and annoying, blepharitis is neither contagious nor does it pose any serious or long-term threat to your sight.
What Causes Blepharitis?
The exact cause of blepharitis remains undetermined. However, certain factors definitely increase your risk. These include:
- Bacterial Infection: Anterior eye inflammation is generally thought to be rooted in poor hygiene, which often results in bacterial overgrowth along the margins of the eyelids and base of the eyelashes. Staph bacteria, which normally and harmlessly reside on the surface of human skin, tend to proliferate rapidly in the absence of proper skin cleanliness. An excessive presence of bacteria in the folds and crevices of the eyelids can set the ground for an infection and symptomatic redness, irritation, and inflammation.
- Meibomian Gland Dysfunction: Posterior blepharitis usually results from malfunctioning oil glands located along the margin of the eyelid where the eyelashes are attached. When these tiny glands called meibomian glands become clogged due to debris, skin flakes, or inflammation, the balance of the water and oil layer of the tear film is disturbed. As a result, the eyelids become dry, irritated, and inflamed.
- Mite Infestation: Bacterial overgrowth on the eyelids can lead to the formation of a plaque-like biofilm, which provides the perfect toxic environment for an eyelash mite called Demodex to thrive and multiply. A Demodex mite infestation rarely presents any symptoms, and dermatological problems such as blepharitis usually occur when these parasites are present in excessive densities or affect someone with a compromised immune system.
- Other Skin Conditions: Blepharitis is also associated with certain other dermatological conditions including ocular rosacea, seborrheic dermatitis (dandruff of the scalp and eyebrows), eczema, and psoriasis.
- Medication: Eyelid inflammation can also occur as a side effect of certain medications.
What are the Common Signs and Symptoms of Blepharitis?
The typical signs and symptoms that identify a case of blepharitis include:
- Excessive tearing due to watery eyes
- Red and swollen eyelid
- Greasy eyelashes that stick together
- Crusting of the eyelashes
- Dandruff-like flakiness around the eyelid margin
- Minor irritation and itching of the eyelids
- Burning or stinging sensation in the eyes
- Foreign body sensation in the eye: grittiness that makes you feel like you have something in your eye
- More frequent blinking
- Photophobia or increased sensitivity to light
In severe cases, blepharitis can lead to:
- Misdirected eyelash growth
- Loss of eyelashes (madarosis)
- Blurry vision
- Inflammation of the eye tissue, particularly the cornea
- A secondary infection if you constantly touch and rub the irritated area, especially with unclean hands, as this further spreads the bacteria
- Increased discomfort in wearing contact lenses, as blepharitis adversely affects natural eye lubrication
- Scarring of the eyelid due to prolonged blepharitis
- Dry eye because of the reduced oil secretions caused by an abnormality in the meibomian glands
Blepharitis usually affects both eyes equally, but in some cases, the symptoms may be more pronounced in one eye than in the other. The symptomatic discomfort associated with this condition may be intermittent or constant but is usually worst in the morning for most patients.
How is Blepharitis Diagnosed?
Diagnosing blepharitis involves a thorough eye examination, with a special focus on the eyelids and the front of the eyeball.
Medical History/Symptoms: Your physician will start off by inquiring about your symptoms and your complete medical history. This line of questioning will help the doctor shortlist the type of blepharitis or determine any other general health issue that may be contributing to the discomfort.
External Examination: Next, the doctor will conduct a careful physical examination of the eye, possibly with a special magnifying instrument to get a closer look under a bright light source. He/she will assess the lid structure and margins, skin texture, meibomian gland openings, and eyelash appearance to pin down the specific type of blepharitis.
What is the Standard Treatment for Blepharitis?
Blepharitis treatment primarily aims at providing symptomatic relief rather than resolving the condition. The standard approach is to adopt proper self-care measures, such as washing your eyes and using warm compresses, to minimize the eyelid irritation and inflammation. In most cases of blepharitis, such preliminary measures suffice to provide relief.
However, if you fail to register any success, the doctor may recommend certain prescription treatments depending upon your individual condition. The typical medical options available for the treatment of blepharitis include the following:
- Infection-Fighting Medications: Topical antibiotics for blepharitis are available in the form of eye drops, creams, and ointments. Some commonly prescribed options include erythromycin or bacitracin ointment, which works by eliminating the excess blepharitis-causing bacteria or other microbes on the eyelids. Keep in mind that these are normal bacteria that reside in your skin. If topical antibiotics fail to provide relief and resolve the bacterial infection, your doctor may suggest an oral antibiotic. Sometimes, an oral antibiotic used to treat acne may be helpful.
- Anti-inflammatory Medications: Corticosteroids in the form of eye drops or ointments may be prescribed to help control the inflammation along with topical antibiotics. The physician will often prescribe a combination of antibiotic and anti-inflammatory medications.
- Treating the Underlying Condition: If your blepharitis is found to be stemming from some other skin condition such as seborrheic dermatitis or ocular rosacea, the doctor will outline an appropriate treatment strategy for the underlying problem. Addressing the root cause will help control your blepharitis symptoms as well.
- Clinical Eyelid Scrubbing: The doctor may prescribe certain in-office eye hygiene procedures to unclog the meibomian glands. For instance, electromechanical lid margin debridement (such as BlephEx treatment) helps remove the biofilm formed by the accumulation of bacteria, debris, and Demodex mites on your eyelids, which is often the root cause of blepharitis. Similarly, thermal pulsation treatment (LipiFlow) uses mild heat therapy to melt, loosen, and expel any material blocking the meibomian glands. Intense pulsed light (IPL) therapy is another such method to remove accumulated matter obstructing the eyelid glands and to resume the normal flow of oils into the tear film.
How to Treat Blepharitis Naturally
Outlined below are some tried-and-tested ways to get natural relief from blepharitis.
1. Apply a Warm Compress
A warm compress allows recirculation of blood and promotes healing. It helps dilute the oily secretions from the glands, thus reducing the risk of an enlarged lump.
Also, it aids in loosening the scales and debris around your eyelashes.
- Use a clean washcloth and dip it in warm water to use as a compress.
- Wring it out and place it over your closed inflamed eyelid for a few minutes.
- Repeat three to four times, dipping the washcloth again in warm water as it cools down.
- Clean any oily debris or scales collected on the eyelid after the process, using another clean cloth.
If both of your eyes are infected, use a separate washcloth for each eye.
Alternatively, you can stand under a hot shower with your eyes closed for 5 minutes daily to aid the healing process.
2. Maintain Eyelid Hygiene
Practicing good hygiene habits can help prevent the recurrence of blepharitis. Good hygiene is important for the treatment of eyelid inflammation.
A study published in Cochrane Database Systematic Reviews corroborates the practice of good hygiene in providing relief from the symptoms of anterior and posterior blepharitis.
Regularly clean your eyelids with lukewarm water or a prescribed cleaning solution. This will prevent crust formation on the lashes and inhibit the accumulation of oil residues and scaly patches on the eyelids.
3. Keep Your Eyelids Clean
You need to gently clean your eyelids often if you are suffering from blepharitis. Cleaning your eyes helps prevent flaking and the accumulation of oily residues and scaly patches on the eyelids that can eventually delay the healing process.
Below is a simple method recommended by the American Optometric Association for eyelid cleaning.
- Prepare a solution of 2–3 drops of baby shampoo and 1 cup of clean warm water.
- Dip a clean cotton ball into the solution.
- Use it to gently scrub the base of your eyelashes for 15 seconds per eyelid.
- Rinse both your eyes with cool water to get rid of any remaining residue.
- Gently pat your eyelid dry using a soft towel.
- Repeat this remedy two to three times a day.
4. Eat Foods Rich in Omega-3 Fatty Acids
Omega-3 fatty acids are anti-inflammatory and can help ease blepharitis symptoms especially when associated with ocular rosacea.
These fatty acids promote the healthy functioning of the meibomian glands, which are responsible for the proper lubrication of the eyes and eyelid comfort.
A 2013 study published in the International Journal of Ophthalmology reports that omega-3 fatty acids have a synergistic effect on dry eye syndrome, blepharitis, and meibomian gland disease. However, further studies are needed to evaluate the role of omega fatty acids in tear production and secretion.
- Eat foods rich in omega-3 fatty acids, such as salmon, tuna, trout, flaxseeds, and walnuts.
- You can also take supplements. For the correct dosage, always consult your doctor.
How Can Blepharitis be Prevented?
- Always wash your face and make sure your eyelids and eyelashes are clean before going to bed.
- Never go to bed with your eye makeup on. Use a mild cleanser to remove any trace of facial and eye makeup before you call it a night. A bedtime cleansing routine is essential for decongesting your pores and allowing your skin to breathe and regenerate overnight.
- Wipe away any excess tears or eye drops from your eyelashes.
- Do not use contaminated eye makeup products.
- Do not share your eye makeup and tools with others.
- Do not rub your eyes, especially with dirty hands, at any cost.
- If suffering from dandruff, use an effective antidandruff shampoo to deal with the problem.
- If you suspect that you have head lice, consult your doctor for appropriate treatment without any delay. Addressing the lice situation early is the best way to prevent a full-fledged infestation.
- If you wear contact lenses, practice extra-precaution as you have to apply a foreign object on your eyes for prolonged periods. Always handle your lenses with clean hands. Aside from maintaining proper personal hygiene, keep your lenses and lens case clean as well.
- Get your eyes checked by an expert if you feel any irritation or burning sensation.
- Avoid touching your eyes with dirty hands.
- Do not rub itchy eyelids, no matter how much you feel like doing it. It can spread an existent infection to the other eye.
- You can also use moist black or green tea bags to reduce the pain and inflammation. Simply place a moist tea bag over your closed eyelids for a couple of minutes.
- Use a thin slice of freshly cut potato to reduce the swelling, pain, and itching. Place the slice over your inflamed eyelids for a few minutes.
- Use a lubricant eye drop to relieve dry eyes.
- If the cause of blepharitis is dandruff, mites, or lice, take steps to eliminate the causes to speed up the healing process.
- You can also consult your doctor to get an antibiotic prescription to treat your condition.
When to See a Doctor?
One must consult a doctor about eyelid inflammation (blepharitis) if the symptoms do not improve despite regular and adequate eyelid hygiene. Because blepharitis is usually chronic in nature, chances are that it may not resolve completely even with successful treatment.
Be sure to visit your doctor if your eyelashes start falling off or if only one of your eyes is affected, as these are also warning signs for localized eyelid cancer.
Expert Answers (Q&A)
Answered by Dr. Annie Negrin, MD (Ophthalmologist)
Is blepharitis curable in the long run?
Blepharitis can be cured with proper treatment and patience on part of both the physician and the patient. This is a form of the ocular surface disease that can be especially tough to treat in patients with other dermatologic and/or inflammatory conditions such as rosacea.
Often, treatment involves patient compliance with compresses and hygiene, along with proper eye drops or ointments to prevent infection and decrease the inflammation.
Can stress lead to blepharitis?
Once we realize that blepharitis is a disorder of lipid (oil) producing glands, we can understand what factors can be affecting them. In this case, when we are stressed, our stress hormone levels (like cortisol) can skyrocket.
Oil glands can be heavily influenced by hormonal regulation, as any teenager will tell you. So stress most certainly can affect the way these glands produce, secrete, and clear any oily material.
Can eyelids grow back after blepharitis?
Unfortunately, parts of the eyelid architecture that are lost from the chronic scarring of blepharitis usually do not grow back in a normal fashion. These lid irregularities can lead to worsening of dry eye symptoms, so it is important to treat it.
Does applying manuka honey help treat blepharitis?
Manuka honey is known for its strong antimicrobial properties, mainly because of its very high concentration of methylglyoxal (MG) compared to other types of honey. It is a great natural antibiotic to put on wounds and ulcers. I do not tend to recommend using this in or around the eyes and delicate lid tissue.
Regular lid hygiene, as described, is great prevention of bacterial overgrowth. I would stick to using the honey for minor scrapes and burns!
Please provide some details about the condition of chalazion for the benefit of our readers.
Blepharitis (from Greek, meaning “inflamed eyelids”) is actually caused by a clogging of the oil glands that run the length of our eyelids. We have dozens of these glands on the upper and lower lids, and they open up just at the base of the eyelashes. This oily material is necessary for a healthy tear film.
With chronic clogging over the glands over time, you develop the chronic problem of blepharitis; tearing, burning, red itchy eyes, and a feeling of sand-like substance in the eyes. With blepharitis can come the problem of one of these many baseline-clogged glands getting very clogged until you feel a bump, or “stye” along the lid.
Dr. Anne Negrin, MD: Dr. Negrin attended Cornell University and received her MD from New York Medical College. She completed a year of internal medicine training at North Shore-LIJ Hospital in Manhasset, Long Island, and then completed her Ophthalmology residency training at St. Vincent’s Catholic Medical Centers of Brooklyn and Queens. A Board Certified Comprehensive Ophthalmologist; she sees patients from newborns to senior years.
Dr. Negrin writes regularly on a variety of health and wellness topics, and can also be seen on various TV and cable news shows as a contributing medical commentator. She runs a private practice in Westchester, NY and is a passionate educator.
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- Lee C-Y, Chen H-C, Lin H-W, et al. Blepharitis as an early sign of metabolic syndrome: a nationwide population-based study. British Journal of Ophthalmology. https://bjo.bmj.com/content/102/9/1283.full. Published September 1, 2018.
- Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Current neurology and neuroscience reports. https://www.ncbi.nlm.nih.gov/pubmed/22592706. Published May 16, 2012.
- American Optometric Association. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/blepharitis.
- Rahul Bhargava, Prachi Kumar, Manjushrii Kumar, Namrata Mehra, Anurag Mishra. A randomized controlled trial of omega-3 fatty acids in dry eye syndrome. International Journal of Ophthamology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874521. Published 2013.