Blepharitis

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About Blepharitis

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About Blepharitis

Blepharitis affects both children and adults. It causes inflammation of the eyelids, commonly at the edges, and both eyes are usually affected. Blepharitis can be complicated to diagnose because a number of overlapping factors may be responsible.

While it is not generally serious, it may become uncomfortable and it tends to recur, so expect to manage the condition rather than cure it.

Signs & Symptoms

Signs & Symptoms

Typically, symptoms flare up from time to time, but you may have long periods without any symptoms.

  • The main symptom is sore eyelids with both eyes usually affected
  • Eyes may feel gritty, itchy or as though they are burning
  • Eyelids may look inflamed or greasy
  • Eyes may become sticky with discharge, particularly in the morning
  • Sometimes tiny flakes or scales appear on the eyelids, which look like small flakes of dandruff
  • Crusts may develop at the base of eyelashes. One or more of the tiny glands of the eyelids (meibomian glands) may block and fill with an oily fluid

Other conditions commonly associated with blepharitis are dry eye syndrome, seborrhoeic dermatitis and rosacea (facial flushing, spots, and central facial redness).

Some of these symptoms can be caused by problems other than blepharitis. If you have pain in your eye or feel sensitive to light or your sight is affected, contact your GP or optometrist straight away.

Types & Causes

Types & Causes

  • Staphylococcal blepharitis

    This type of blepharitis is thought to be caused by a bacteria called staphylococcus. This bacterium commonly lives in low numbers on the skin without doing any harm. However, in some people this bacterium causes an infection of the eyelids, resulting in blepharitis.

  • Seborrhoeic blepharitis

    This type of blepharitis is closely associated with a skin condition called seborrhoeic dermatitis where the affected skin becomes more oily and can become scaly. Seborrhoeic dermatitis typically causes bad dandruff and sometimes a rash, commonly on the face and upper body. A type of yeast called Malassezia furfur is involved. This yeast lives in the oil (sebum) of human skin in most adults and usually does no harm. However, in some people the yeast seems to trigger an inflammatory reaction, causing the blepharitis.

  • Meibomian blepharitis

    This is also known as meibomian gland dysfunction. The tiny meibomian glands in the eyelids lie just behind the eyelashes. You have about 25-30 meibomian glands on each upper and lower eyelid. They make a small amount of oily fluid which comes out on the inside of the eyelids next to the eye. This oily fluid forms the outer layer of the tear film which lubricates the front of the eye. People with meibomian blepharitis are thought to have a problem with their meibomian glands and the fluid they produce which may lead to eyelid inflammation. This also explains why people with meibomian blepharitis often have dry eyes, as the fluid they make may not be adequate to lubricate the eye.

Diagnosis

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Diagnosis

Each case of blepharitis may have multiple causes, and often it is not possible to tell the difference between them. In addition, seborrhoeic blepharitis may occur together with meibomian blepharitis. Your GP will be able to give you the most accurate diagnosis and tell you how to treat the condition.

For healthcare professionals, advanced information about diagnosis is available on our Practitioner Site.

Complications

Complications

In most cases, blepharitis is uncomfortable but not serious or sight-threatening. Complications are therefore uncommon but they can occur. They include:

  • Chalazion (meibomian cyst). This is a painless swelling, most prominent on the inside of the eyelid
  • Stye. This is a painful infected swelling most prominent on the outside of the eyelid due to an infection of the root (follicle) of an eyelash
  • Contact lens wearers may find their lenses feel uncomfortable when they have a flare-up of blepharitis
  • Eyelashes can be affected, including loss of eyelashes (madarosis), misdirection of eyelashes towards the eye (trichiasis) or loss of the colour of the eyelashes (poliosis)
  • Eyelid ulceration and scarring (uncommon). This can cause the eyelid to turn inwards against the eyeball or outwards
  • Inflammation of the front of the eye (conjunctivitis). This may cause a sore, red eye with discharge or watering
  • Conjunctival phlyctenules. These are small (1-3 mm), hard, triangular, yellowish-white lumps (nodules) surrounded by prominent but tiny blood vessels
  • Inflammation of the cornea (keratitis), ulceration, and scarring. This complication is rare but serious as it can affect sight. See a doctor urgently if you develop eye pain or any loss of vision from the affected eye


Treatment

Treatment

  • Treatment Overview

    There is no one-off cure for blepharitis, as the inflammation tends to recur if you do not keep up with treatment. However, with regular treatment, symptoms can usually be eased and then kept to a minimum. This helps to prevent flare-ups. The aim of treatment is to control or manage blepharitis, not to cure it.  Treatment depends on the type of blepharitis. The key to treating most types of blepharitis is keeping the lids clean and free of crusts.

    The main and important treatment is regular eyelid hygiene. Other treatments that may be needed include antibiotics, artificial tear drops and specific treatment for associated conditions. “Lid hygiene” should be continued even when the symptoms are not there to prevent the condition causing further problems. Applying warm compresses can loosen the crusts. Then gently scrub the eyelids with a mixture of water and baby shampoo or an over-the-counter lid-cleansing product. In cases involving bacterial infection, an antibiotic may be prescribed. 

    People with blepharitis might find the following helpful:

    • If the glands in the eyelids are blocked, massage the eyelids to clean out oil accumulated in the eyelid glands.
    • Use artificial tear solutions or lubricating ointments, if prescribed.
    • Use anti-dandruff shampoo on the scalp.
    • Limit or stop using eye makeup during treatment, as it makes lid hygiene more difficult.
    • Temporarily discontinue wearing contact lenses during treatment.

    Some blepharitis cases may require more complex treatment plans. Blepharitis seldom disappears completely. Even with successful treatment, blepharitis may reoccur. 

  • Regular eyelid hygiene

    Regular eyelid hygiene is important for the treatment and prevention of blepharitis. The aim is to soothe the eyelids, unplug any blocked glands and clear out any stagnant oily secretions from these glands. The eyelids are cleaned and debris is removed. Any contact lens should be removed before following the routine.

    This is a daily routine that consists of three parts: 

    Warmth

    The skin is softened and any crusts attached to the eyelids are loosened. It also allows the oily secretions to flow more freely. Warmth helps in unplugging any blocked glands and allow the oily secretions to flow more readily. Warmth applied to the eyelids for five to ten minutes is sufficient to do this. The traditional method is to press on the eyelids gently with a flannel (facecloth) soaked in very warm water for 5-10 minutes. If the flannel cools, keep re-warming it in the warm water.

    Another alternative is to use a specially designed reusable heat bag which could be placed over the eyes for about five minutes. The advantage of a heat bag over a hot flannel is that the heat is retained for many minutes and so it keeps a constant warmth over the eyes. Such a bag should be available with your doctor or ophthalmologists and should be used upon their advice. 

    Massage

    Massaging the eyelids immediately after applying the warmth helps push out the oily fluid from the tiny meibomian glands. Massage should be done along the length of the upper and lower eyelids towards the eye that helps in moving the oily secretions toward the edge of the eyelid so that they can come out of the glands. Massaging should neither be too gentle nor too firm. It should be relatively comfortable and one should not press hard enough to actually hurt your eyeball under the closed lids.

    Clean

    After warmth and massage, eyelids should be cleaned. This can be done by various ways such as using cotton wool bud that has been dipped in diluted baby shampoo. Special eyelid scrubs are also available with opticians/optometrists.

  • Artificial tear drops

    Blepharitis is often associated with dry eyes. Therefore, artificial tear drops may help ease symptoms. These come as eye drops and gels. You may need to use them regularly to keep symptoms away. Please contact your local doctor or ophthalmologists to learn more about them.

  • Antibiotic treatments

    Antibiotic eye ointment or drops may be advised for a while if an eyelid becomes infected. Antibiotics are prescribed by the general practitioners and /or ophthalmologists. They are available in various forms such as ointment, eye drops, gel, oral formulations etc. Please contact your local GP or health care professional for further advice on antibiotics.

    Bacterial eye infections are generally treated topically with eye drops and eye ointments. Systemic administration is sometimes appropriate in blepharitis.

    For severe cases of blepharitis, antibiotic-steroid combination ointments may be used to decrease inflammation in the short term.

  • Steroids

    Many antibacterial preparations also incorporate a corticosteroid but such mixtures should not be used unless a patient is under close specialist supervision. In particular they should not be prescribed for undiagnosed ‘red eye’ which is sometimes caused by the herpes simplex virus and may be difficult to diagnose.

    Please note1There are many antibiotic available for the treatment of blepharitis. All the treatment options might not be available in your locality and may not suit you. So, it is advisable and recommended to visit your doctor or ophthalmologist before deciding on any medication. 

  • Further Advice

    • Wearing eye make-up, particularly eyeliner, may make symptoms worse. It is best to avoid eyeliner, particularly during a flare-up.
    • Rubbing your eyelids may make inflammation worse, so try to avoid doing this.
    • As mentioned above, blepharitis commonly develops in people with seborrhoeic dermatitis, rosacea or dry eye syndrome. If relevant, treatment of these other conditions may also help to ease symptoms of blepharitis.

    Please consult your doctor or ophthalmologist immediately if your eye becomes increasingly red or painful, your sight becomes more blurred or you develop very noticeable and spreading redness together with a lot of swelling of the eyelids.

Disclaimer

Disclaimer

Please note that this is an international, above country level, disease awareness website for patients.