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Blepharitis

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Blepharitis



Introduction 

Blepharitis is a condition where the edges of the eyelids become inflamed (red and swollen). 

It is a common condition, accounting for an estimated 1 in 20 eye problems reported to GPs. Blepharitis can develop at any age, but is more common in people over 40.

Signs of blepharitis can include:



itchy and sore eyelids



eyelids that stick together and are difficult to open, particularly when you wake up



eyelashes that become crusty or greasy



 

When to see your GP

See your GP if you are unable to control the symptoms of blepharitis with simple cleaning measures alone (see below).

Your GP can usually diagnose blepharitis based on your symptoms and an examination of your eyes. They may refer you to an ophthalmologist (eye specialist) for further tests and treatment if you have severe symptoms, or initial treatment is unsuccessful.

What causes blepharitis?

Blepharitis can be caused by an infection with Staphylococcus bacteria, or as a complication of a skin condition, such as:



seborrhoeic dermatitis – a condition that causes the skin to become oily or flaky



rosacea – a condition that causes the face to appear red and blotchy



Blepharitis is not contagious. 

 

How blepharitis is treated

Blepharitis is usually a long-term condition. Most people experience repeated episodes, separated by periods without symptoms.

Blepharitis cannot usually be cured, but a daily eyelid-cleaning routine that involves applying a warm compress – gently massaging your eyelids and wiping away any crusts – can help control the symptoms. 

More severe cases may require antibiotics that are either applied to the eye or eyelid directly, or taken as tablets.

 

Complications

Blepharitis is not usually serious, although it can lead to a number of further problems.

For example, many people with blepharitis also develop dry eye syndrome (a condition where the eyes do not produce enough tears or dry out too quickly), which can cause your eyes to feel dry, gritty and sore.

Serious, sight-threatening problems are rare, particularly if any complications that develop are identified and treated quickly.

 



Blepharitis can cause the eyelashes to become crusty 



Eyelid problems

Causes of common eyelid problems, such as swollen eyelids, gritty, itchy or flaky eyelids, and droopy eyelids

Symptoms of blepharitis 

Most people with blepharitis experience repeated episodes, separated by long periods with no symptoms.

The symptoms of blepharitis, vary depending on the specific cause, but can include:



itchy, sore and red eyelids



eyelids that stick together and are difficult to open when you wake up



eyelashes that become crusty or greasy



a burning, gritty sensation in your eyes



an increased sensitivity to light (photophobia)



the edges of your eyelids (eyelid margins) becoming swollen



finding contact lenses uncomfortable to wear



abnormal eyelash growth or loss of eyelashes, in severe cases



In most cases both eyes are affected, and the symptoms tend to be worse in the morning.

Visit your GP if you have persistent symptoms of blepharitis that are not being controlled by simple eyelid hygiene measures. Read our page on treating blepharitis for more information.

 

Symptoms of other conditions

Blepharitis is sometimes associated with other health conditions, which may result in other symptoms.

For example, as well as the above symptoms, you may also have:



oily skin and dandruff – if you also have seborrhoeic dermatitis (a condition that causes your skin to become oily or flaky)



a constantly red face and spots – if you also have rosacea (a skin condition that mainly affects the face)



dry, gritty, sore or red eyes – if you also have dry eye syndrome (a condition where your eyes do not make enough tears or your tears evaporate too quickly)



 

Causes of blepharitis 

Blepharitis occurs when the edge of your eyelids become inflamed (they turn red and begin swelling). It is usually caused by an infection or a skin condition.

There are two main types of blepharitis:



anterior blepharitis – where the inflammation affects the skin around the base of your eyelashes



posterior blepharitis – where the inflammation affects your Meibomian glands (found on the inside edge of your eyelids)



Some people experience both types of blepharitis, as the causes are often linked.

Anterior blepharitis

Anterior blepharitis can be caused by either a bacterial infection or a skin condition called seborrhoeic dermatitis.

Staphylococcus bacteria are most commonly associated with blepharitis. These bacteria live harmlessly on the skin of many people but, for unknown reasons, they can cause the eyelids of some people to become inflamed.

Seborrhoeic dermatitis is a skin condition that causes skin to become oily or flaky, and it can sometimes irritate the eyelids. Seborrhoeic dermatitis often causes both anterior and posterior blepharitis at the same time.

Anterior blepharitis has sometimes been linked to demodex, which are microscopic mites that live on eyelashes. These mites are usually harmless, but may cause blepharitis in some people – possibly due to the eyelids becoming damaged or because of a sensitivity reaction. Some types of demodex mite have also been linked to cases of posterior blepharitis.

 

Posterior blepharitis

Posterior blepharitis occurs due to a problem with the Meibomian glands, which are found on the inside edge of your eyelids.

The Meibomian glands are responsible for producing an oily substance that makes up part of your tears. A problem in these glands can lead to excess production of this oily substance or a blockage in the glands, which can cause the eyelids to become irritated and inflamed.

Excessive production of the oily tear substance is often linked to seborrhoeic dermatitis (see above), while blockages in the Meibomian glands are often due to a skin condition called rosacea.

Rosacea is a common, long-term skin condition that mainly affects the face. The first symptoms are usually episodes of flushing (when the skin turns red), but eye problems such as blepharitis develop in around half the people with the condition, as it progresses.

 

Treating blepharitis 

Blepharitis cannot usually be cured, but the symptoms can be controlled with good eyelid hygiene.

Blepharitis is a long-term (chronic) condition. Most people experience repeated episodes, separated by periods with no symptoms.

Eyelid hygiene

It's important to clean your eyelids every day if you have blepharitis, whether or not you currently have any symptoms or are using one of the medications mentioned below. Good eyelid hygiene can help to ease your symptoms and prevent it happening again.

Follow the steps below to keep your eyelids clean:



Apply a warm (but not hot) compress to your closed eyelids for 5 to 10 minutes to help melt the oils that may have built-up in the glands behind your eyelids. A cloth or flannel warmed with hot water will usually be fine, although special eye packs that are heated in the microwave are available to buy.



Gently rub your closed eyelids vertically and horizontally with your finger or a cotton wool bud to help loosen any crusting, and push out any oils that may have built up.



Use a cloth or cotton bud with warm water and a small amount of cleaning solution (see below), and gently wipe the edge of your eyelids to clean them. Try to avoid touching your eye and don't clean the inside of your eyelids, as this can irritate them.



These steps should be carried out twice a day at first, then once a day when your symptoms have improved.

Try to avoid wearing eye make-up, particularly eyeliner and mascara, as this can make your symptoms worse. If you do wear eye make-up, make sure it is a type that washes off with ease so you can clean your eyelids every day more easily using the method described above.

 

Cleaning solution

There are many recipes for cleaning solutions and the best proportions or products to use can vary, depending on the individual.

A popular recipe involves pouring a pint of boiled water into a bowl, adding either a drop of baby shampoo or tea tree shampoo – or a teaspoon of bicarbonate of soda – and allowing it to cool before using. You could also use a commercial eyelid-cleaning solution.

Your GP or pharmacist can advise you about suitable cleaning solutions, although you may need to try more than one product to find one that suits you.

 

Topical antibiotics

If you have blepharitis that does not respond to regular cleaning, you may be prescribed a course of antibiotic ointments, creams or eye drops (topical antibiotics). You will usually need to use these for around four to six weeks.

Ointments and creams should be rubbed gently onto the edge of your eyelids, usually several times a day at first, using either clean fingers or a cotton bud. Once your condition begins to improve, you may only need to do this once a day, usually at night after cleaning your eyelids using the method outlined above.

 

Cautions

You should try to avoid wearing contact lenses when using antibiotic eye drops, as the drops may build-up behind the lenses and irritate your eye. Let your GP know if you want to keep wearing contact lenses, as they may recommend preservative-free drops that are less likely to irritate your eyes. 

If you are using more than one type of eye drop at the same time of day, leave at least five minutes before applying the second type of drops to your eyes.

You may experience some mild stinging or burning when applying antibiotic ointment or drops, but this should pass quickly. Do not drive if the ointment blurs your vision.

 

Oral antibiotics

You may be prescribed antibiotics to take by mouth once or twice a day if your blepharitis does not respond to other treatments. Oral antibiotics may also be recommended at the start of your treatment if it's thought that rosacea is aggravating your symptoms.

Most people respond well within the first few weeks of treatment, although you may need to take them for up to three months. It's important for you to finish the course of antibiotics, even if your symptoms get better.

 

Cautions

Some oral antibiotics used to treat blepharitis have been known to make people more sensitive to the effects of the sun. Therefore, while you are taking them, you should avoid prolonged exposure to sunlight and using sun lamps or sun beds.

Oral antibiotics can also sometimes affect unborn and developing babies, as well as young children, so they are not normally used to treat children under 12 years of age or women who are pregnant or breastfeeding.

Side effects of oral antibiotics are rare because the dose is relatively low. However, they may include vomiting, diarrhoea and, in women, yeast infections.  

 

Treating other conditions

Depending on the suspected cause of your condition and any other symptoms you have, you may also need additional treatment.

For example, if you have seborrhoeic dermatitis or dandruff, you may need to use an anti-dandruff shampoo on your scalp and eyebrows.

If you have dry eye syndrome, which frequently occurs alongside blepharitis, you may need separate treatment for this, such as "artificial tear" eye drops.

 

Complications of blepharitis 

Blepharitis can cause many different problems, although serious complications are rare.

Some of the complications associated with blepharitis can potentially affect your vision, although your eyesight should not be permanently damaged if these problems are identified and treated quickly.

Some of the main complications of blepharitis are described below.

 

Dry eye syndrome

Dry eye syndrome is a common complication of blepharitis. It occurs when your eyes do not make enough tears, or your tears evaporate too quickly. This can lead to your eyes drying out and becoming inflamed, which can cause them to feel dry, gritty and sore.

Dry eye syndrome can be caused by the same skin conditions that can cause blepharitis – seborrhoeic dermatitis (a condition that causes your skin to become oily or flaky) and rosacea (a condition that mainly affects the face) – as these can also affect the quality of your tears.

Speak to your GP if you have constantly dry eyes. They may recommend using eye drops containing "artificial tears" that are often are available from pharmacists without a prescription.

 

Conjunctivitis

Conjunctivitis is an inflammation of the conjunctiva. This is the transparent membrane that covers the white part of the eyeball and the inner surfaces of the eyelids.

Conjunctivitis can occur when bacteria in the eyelid infect the eyes. The condition is not usually serious and should not affect your vision.

Most cases of conjunctivitis are mild and will pass in one to two weeks without the need for treatment, but you should contact your GP if you think you have it. If you wear contact lenses, you should consult your optometrist or contact lens practitioner.

Antibiotic eye drops may be prescribed if your symptoms continue, or you have repeated infections.

 

Meibomian cysts

A Meibomian cyst is when there is swelling on the inside of your eyelids. A cyst can develop if one of your Meibomian glands (which produce an oily substance that forms part of your tears) becomes inflamed as a result of blepharitis.

The cysts are normally painless, unless they get infected. In these cases, you should see your GP, as antibiotics may be needed. Applying a hot compress to the cyst should help reduce the swelling, although cysts often disappear by themselves.

If a cyst does not disappear, it can be removed with a simple surgical procedure carried out under local anaesthetic (painkilling medication).

 

Styes

A stye is a painful swelling that produces pus and develops on the outside of your eyelid. Styes are caused by a bacterial infection of an eyelash follicle (the base of your eyelash).

A mild stye can be treated by applying a warm compress (a cloth warmed with hot water) to the area.

See your GP if you have a very painful stye that is not getting better. If this happens, your GP may drain it using a small needle.

 

Damage to the cornea

Severe cases of blepharitis that do not respond to treatment can sometimes cause the cornea (the transparent layer at the front of the eye) to become inflamed and damaged. This is called keratitis.

This damage can lead to the development of ulcers or scarring on the cornea, which could potentially threaten your sight.

Symptoms of keratitis include sudden eye pain, sensitivity to light and a worsening in vision.

Contact your GP immediately if you experience any of these symptoms. If you can't, visit your nearest accident and emergency (A&E) department.



Blepharitis