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Blepharitis: Causes, symptoms and treatment

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Blepharitis is inflammation of the eyelids that causes red, swollen eyelids and crusty eyelashes.

Also called chronic blepharitis, the condition often is difficult to treat and frequently reoccurs periodically. 

Blepharitis (pronounced “blef-uh-RYE-tis”) is also quite common. A survey of eye doctors in the U.S. revealed that between 37% and 47% of their patients have some degree of eyelid inflammation.

Blepharitis is not contagious and usually doesn’t cause serious harm to your eyes or vision, but it can be unsightly and uncomfortable.

Causes

There are several possible causes of blepharitis, including:

  • Bacterial eyelid infection

  • Meibomian gland dysfunction

  • Dry eyes

  • Fungal eyelid infection

  • Parasites (eyelash mites or lice)

  • Seborrheic dermatitis (dandruff of the scalp and eyebrows)

Blepharitis and dry eyes often occur at the same time, causing confusion whether dry eye causes blepharitis or blepharitis causes dry eye.

This happens so often that some researchers and eye doctors now believe these two conditions may be part of a single chronic eye problem called dry eye blepharitis syndrome (DEBS).

According to supporters of this theory, dry eye is simply the late manifestation of blepharitis, and treating blepharitis will also prevent, reduce or eliminate dry eye symptoms.

Blepharitis is usually associated with an overgrowth of bacteria that live along the margins of the eyelids and at the base of the eyelashes. Over time, these bacteria multiply and create a structure called a biofilm.

This biofilm becomes a toxic environment — like the plaque that forms on your teeth. Parasitic eyelash mites called Demodex feed on the biofilm, which in turn leads to an overgrowth of these mites that causes a worsening of the eyelid inflammation.

Bacteria in the eyelid biofilm also produce substances called exotoxins that cause inflammation of oil-secreting glands in the eyelids called meibomian glands. This causes a condition called meibomian gland dysfunction, which causes (and worsens) dry eye discomfort.

Blepharitis also is frequently associated with skin conditions, such as ocular rosacea, eczema, dandruff and psoriasis. 

Symptoms

The most common symptoms of blepharitis are:

Conditions associated with blepharitis

If you have chronic blepharitis, it’s likely you may also have one or more associated conditions or complications, including:

  • Stye. A stye is a bacterial infection at the base of an eyelash or inside an oil-producing gland in the eyelid. A stye causes a painful red bump or pimple at the margin (edge) of an eyelid. [Read more about styes.]

  • Chalazion. A chalazion is a clogged oil gland in an eyelid that may begin as a stye. It causes a red, swollen bump on the eyelid. [Read more about a chalazion.] 

  • Dry eye syndrome. Clogging of the oil glands in the eyelid can cause the tear film to evaporate quickly, leading to dry eye problems. [Learn about dry eye syndrome.]

  • Eyelash problems. Chronic blepharitis can cause scarring of the lid margin that leads to misdirected eyelashes or even loss of eyelashes. 

  • Cornea problems. If chronic blepharitis causes eyelashes to grow toward your eyes, the misdirected lashes can rub against the clear front surface of the eye, leading to a painful corneal abrasion. Also, dry eyes associated with blepharitis can increase your risk of corneal eye infections

  • Pink eye. Chronic blepharitis can also cause episodes of bacterial pink eye (conjunctivitis). [When blepharitis and pink eye occur together, the combined condition is called blepharoconjunctivitis.] 

 Blepharitis is also a common cause of contact lens discomfort, forcing many people to give up wearing contacts.

SEE ALSO: Sore eyelids: How to relieve eyelid pain

Treatment

Treatment of blepharitis should begin with a visit with your eye doctor to determine the cause of your eyelid inflammation. Your doctor will examine your eyes and eyelids to evaluate whether you have blepharitis and determine what type of blepharitis treatment is most appropriate. Typically, blepharitis treatment includes:

SEE ALSO: The fastest way to heal a swollen eyelid

Eyelid scrubs

Gently scrubbing your eyelids removes the buildup of biofilm and excess bacteria from your lid margins. Your eye doctor will typically recommend a daily regimen of warm compresses and lid scrubs to clean your eyelids and reduce the amount of bacteria and Demodex mites on your lids.

Cleaning agents may include prescription eyelid cleansers (Avenova or Cliradex), non-prescription eyelid cleansing pads (Ocusoft; Systane) or diluted baby shampoo.

In-office procedures

Though eyelid scrubs at home are helpful, in-office eyelid hygiene procedures are often recommended for more effective blepharitis treatment. Possible procedures include:

  1. Electromechanical lid margin debridement (such as BlephEx treatment) to efficiently remove bacteria, biofilm and Demodex mites from your eyelids and open clogged meibomian glands.

  2. Thermal pulsation treatment (Lipiflow, for example) to melt and express material obstructing the meibomian glands.

  3. Intense pulsed light (IPL) therapy to open clogged eyelid glands and resume normal flow of oils into the tear film.

Medicated eye drops and/or ointments

Your doctor may also prescribe topical medicines to destroy excess blepharitis-causing bacteria or other microbes on the eyelids — particularly if it appears you have pink eye or some other type of eye infection as well as blepharitis.


Eyelid hygiene tips

Eyelid hygiene is very helpful to treat, control and prevent blepharitis.

To begin, use a clean, warm compress to melt any blocked residue in the oil-secreting meibomian glands in your eyelids. Here's how:

  • Wash your hands, then dampen a clean washcloth with warm (nearly hot) water.

  • Place the washcloth over your closed eyelids for several minutes.

  • Then gently rub your eyelid margin with the washcloth before opening your eyes. (Don't press hard on your eye.)

Follow your eye doctor's recommendations regarding how often to use a warm compress and how long to keep it in place. When you first begin treatment, you may be instructed to do this several times daily, for about five minutes each time. Later on, you might only need to apply the compress once daily.


Cleaning your eyelids

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Use a cotton-tipped swab to apply cleaning solution recommended by your eye doctor. Rub gently around the edges of your upper and lower eyelids, but do not get cleaning solution in your eye.

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The goal of blepharitis treatment is to return your eyelids to a normal, healthy state.

Cleaning your eyelids is the next essential step. Your doctor will recommend what to use for the cleaning agent. Options include warm water, diluted baby shampoo, or an over-the-counter or prescription eyelid cleanser.

To clean your eyelids:

  • Wash your hands, then moisten a clean washcloth, cotton swab or gauze pad with the cleaning solution.

  • Gently wipe your eyelashes and lid margin.

  • Rinse with warm water.

  • Repeat the process for your other eye, using a different washcloth, swab or pad.

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

It's a good idea to minimize use of eye makeup when you have blepharitis, because mascara and other makeup can interfere with eyelid hygiene.

If your doctor recommends an anti-dandruff shampoo for your scalp and eyebrows, make sure you keep the shampoo out of your eyes to avoid irritation.

How to prevent blepharitis

Blepharitis is typically a chronic condition, meaning it can come back frequently and be a recurring problem.

The best way to prevent blepharitis or keep it from coming back is to clean your eyelids daily to prevent the buildup of bacteria, biofilm and Demodex mites on the eyelid margin. A number of non-prescription lid scrub products are available, or you can use the same eyelid hygiene techniques described above.

There are also a number of prescription eyelid cleansing products that may be more effective than baby shampoo or over-the-counter products.

Your doctor might also recommend nutritional supplements like omega-3 fatty acids to help keep your meibomian glands healthy and your eyes moist and comfortable.

If you wear contacts or glasses

If you develop blepharitis while wearing contact lenses, you should discontinue wearing your contacts until the blepharitis has been successfully treated. Wearing contacts when you have eyelid inflammation can result in bacteria and other debris sticking to your lenses and causing pink eye or potentially more serious eye diseases.

If you don't currently have a backup pair of glasses, see your eye doctor for an exam to update your eyeglass prescription.

When buying glasses, consider photochromic lenses, which darken automatically in sunlight and lighten indoors. If you're like some people with dry eyes who experience light sensitivity (photophobia), your eyes may be more comfortable outside with photochromic lenses, such as Transitions-brand lenses. Another advantage: You wouldn't need a separate pair of prescription sunglasses for outdoor wear.

After your blepharitis has been successfully treated, you can resume wearing contacts if that's your preference. If you currently wear reusable contact lenses, consider switching to daily disposable contacts or gas permeable contacts, which may have a lower risk of blepharitis-related problems.

SEE ALSO: Swollen Eyelid FAQs

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Gary Heiting, OD

Gary Heiting, OD, is a former senior editor of AllAboutVision.com. Dr. Heiting has more than 30 years of experience as an eye care provider, health educator and consultant to the eyewear ... Read more