Blepharitis

By Gina White, with updates by Liz Segre;
reviewed by Michael DePaolis, OD

Blepharitis refers to inflammation of the eyelids, particularly at the lid margins. It's a common disorder and may be associated with a low-grade bacterial infection or a generalized skin condition.

Blepharitis occurs in two forms: anterior blepharitis and posterior blepharitis. Anterior blepharitis affects the outside front of the eyelid where the eyelashes are attached. The two most common causes are scalp dandruff and bacteria.

Posterior blepharitis affects the inner eyelid and is caused by problems with the oil (meibomian) glands in the eyelid. Two skin disorders are the cause: acne rosacea and scalp dandruff.

Blepharitis Symptoms and Signs

Regardless of which type of blepharitis you have, you will probably have such symptoms as eye irritation, burning, tearing, foreign body sensation, crusty debris (in the lashes, in the corner of the eyes or on the lids), dryness and red eyelid margins.

It is important to see your eye doctor for treatment. If your blepharitis is bacterial, possible long-term effects are eyelash loss, ectropion, thickened lid margins, dilated and visible capillaries, trichiasis and entropion. The lower third of the cornea may exhibit significant erosion.

Blepharitis Treatments

Blepharitis can be difficult to manage because it tends to recur. Depending on the type of blepharitis you have, treatment may include applying warm compresses to the eyelids, cleansing them, using an antibiotic and/or massaging the lids.

If blepharitis makes your eyes feel dry, your doctor also may prescribe artificial tears or lubricating ointments or suggest silicone punctal plugs. Sometimes steroids are used to control inflammation, but the potential side effects speak against long-term use.

The warm compress portion of treatment is designed to loosen crusts on your eyes before you cleanse them; it can also warm up and loosen the plugs blocking the meibomian glands in meibomianitis.

To use a warm compress, follow these steps:

• Wash your hands, then dampen a clean washcloth with warm water.
• Place the washcloth over your closed eyes.
• Follow your doctor's recommendations regarding how often to use a compress and how long it should be kept in place.

When you first begin treatment, your eye doctor probably will suggest that you do this four times daily, or about five minutes each time. Later on, you might apply the compress once daily for a few minutes.

Cleansing the eyelids is essential to blepharitis treatment. Your doctor will recommend what cleansing agent to use, such as warm water only, salt water, baby shampoo diluted with warm water or a special over-the-counter product made specifically for cleansing the lids.

Clean eyelids by following these steps:

• Wash your hands, then dip a clean washcloth, cotton swab or gauze pad into your cleaning solution.
• Gently wipe across your lashes and lid margin.
• Rinse with cool water.
• Repeat the process for your other eye, but use a different washcloth, swab or pad.

Your doctor may have you clean your lids several times daily to start, and then once daily thereafter.

Antibiotic treatment is recommended only for certain types of blepharitis. Your doctor may prescribe either a topical antibiotic ointment or an oral antibiotic.

If you have meibomian gland dysfunction, your doctor will probably recommend massaging the lids to remove excess oil. He or she will show you the correct technique.

Recently, some authorities have suggested using flaxseed oil supplements (omega-3 fatty acid), either by pill or by liquid, to stabilize the meibomian secretions associated with meibomian seborrheic blepharitis. Be sure to discuss any supplement use with your doctor.

Because blepharitis tends to be chronic, expect to keep up therapy for a long period of time. Depending on the type of blepharitis you have and if you wear contact lenses, your doctor may ask you to stop wearing them during the treatment period and even beyond.

If you wear soft contact lenses, you may be prescribed RGP contacts instead. Another option might be to replace soft lenses more frequently because of the potential for excessive deposit buildup. Some people simply don't do well with contact lenses and will have to consider other options.

It's a good idea never to use eye makeup, which can interfere with eyelid hygiene and massage treatments. With some kinds of blepharitis, you may need to use an anti-dandruff shampoo for your scalp and eyebrows. But take extra care to keep shampoo out of your eyes to avoid irritation.

Some portions of this text were adapted from the article "Managing Lid Disease in Lens Wearers" by Dr. Joseph P. Shovlin and Dr. Michael D. DePaolis, originally published in Review of Optometry in September 2002.

[Page updated January 2009]