Blepharitis or Eyelid Inflammation
Blepharitis (blef-are-eye-tis) is a usually non-contagious and common eye disorder that affects all ages and both sexes, and may be associated with bacterial infection or skin disorders such as rosacea or seborrhea. It inflames the eyelash follicles along the edge of the eyelid, forming dandruff-like scales on the eyelashes. Oil glands (meibomian glands) run along the edges of the eyelids, and when these glands become irritated or inflamed, the oil secretions thicken and do not flow properly. The meibomian secretions are an important part of a healthy tear film, and their absence can cause the tear layer to become unstable or evaporate quickly. Although most experts treat it as a serious condition, blepharitis alone is not known to cause any permanent damage to eyesight. If blepharitis is severe, then related problems affecting the cornea can threaten vision. Eye care professionals usually become aware of the condition in the course of comprehensive eye examinations.
There are many symptoms that may signal the presence of blepharitis or eyelid inflammation. Some of these symptoms are more severe than others, and sometimes a person will not experience any of these symptoms at all. The most common symptoms include:
- Crusty discharge on the lashes or lids, especially when first awakening
- Redness of the eye or eyelids
- Swelling of eyelids and skin around eyes
- Excessive tearing
- Dry eyes
- Blurring of vision
- Loss of eyelashes
- Photophobia (sensitivity to bright light)
- Gritty sensation when blinking
- Fluctuating vision due to secondary dryness and an unstable tear film
Types of Blepharitis
Blepharitis can be divided into two sub-types based on whether it predominantly affects the anterior (front) eyelid structures or the posterior (back) eyelid structures. Some people have predominantly anterior or posterior blepharitis, and some people have both.
Anterior Blepharitis: This type affects the outside front edge of the eyelid, where the eyelashes grow, and is usually caused by bacteria (staphylococcal blepharitis) or dandruff of the scalp and eyebrows (seborrheic blepharitis). In rare cases, it is caused by allergies or an infestation of the eyelashes by mites or lice.
Posterior Blepharitis: This type of blepharitis affects the meibomian glands, which are located just within the eyelid margin. There are twenty to thirty meibomian gland openings on each eyelid margin. The inflammation causes thickening of the oil secretions so that the oil does not flow as well, causing secondary dry eye and chronic inflammation, redness, thickening, and notching of the eyelid margin. This condition may also be referred to as rosacea-associated blepharitis, because it is often seen in people with rosacea.
What Causes Blepharitis?
Blepharitis can develop for a number of reasons. In many cases it is caused either by bacteria or by the skin condition known as seborrhea, which is similar to dandruff. Other times it is caused by severe allergies or plugged oil glands and rosacea. Although it is not as common, blepharitis can sometimes be caused by an infestation of the eyelashes by mites or lice.
Risk factors may include:
- Exposure to allergens
- Dermatitis of the scalp and other body parts
- Oily skin
- Acne rosacea
- Age (it is commonly seen in the young and elderly)
- Exposure to chemical or environmental irritants like smoke or smog
- Hands that remain dirty for most of the day, such as during a work shift, or poor hygiene
Treatment for Blepharitis
Depending on which type of blepharitis you have, there are a variety of ways to treat this condition. With any type of blepharitis, the cornerstone of treatment is keeping the eyes clean and free of debris with hot compresses and gentle lid hygiene.
- Warm compresses are a mainstay of all treatments for blepharitis. The heat and moisture can soften flakes and debris on the eyelashes, making them easier to clean. The heat also helps to encourage the flow of oil from the meibomian glands. Blepharitis is a chronic condition, and it is helpful to make warm compresses a part of your daily routine, and to apply them more often when symptoms flare.
- After a warm compress, gently massage the eyelid margins to prompt the flow of oil from the meibomian glands.
- Gently wash the eyelids and eyelashes with baby shampoo diluted with water, or a commercial eyelid cleanser such as those made by Ocusoft. Wrap a washcloth around your index finger or use cotton swabs to clean. Avoid rubbing too hard, and rinse with warm water when finished.
Additional treatments include:
- Oil containing artificial tears and lubricating ointments to relieve burning, grittiness, and secondary dryness
- Antibiotic drops or ointments
- Short courses of topical steroid drops for flares (only under a doctor’s supervision)
- Oral antibiotics, especially for posterior blepharitis
- Using anti-dandruff shampoo/conditioner on the scalp (for patients with seborrheic dermatitis)
- Reducing time spent wearing eye make-up; always take make-up off before bed
- Discontinuing use of contact lenses until symptoms improve. When a contact lens wearer experiences redness, pain, and/or blurred vision, he or she should always remove the contact lenses and contact his or her eye care provider for advice, as this may signal a more serious issue.
- Avoiding environmental irritants (e.g., dust)
- Taking omega-3 fatty acid supplements, since omega-3 is known to help in the proper function and regulation of the eyelid glands and has an anti-inflammatory effect. Always tell your primary care doctor about any supplements you are taking, as they may interact with other medications you take.
Blepharitis is a chronic and incurable condition, but the symptoms can be controlled with the right treatment regimen. If your blepharitis is severe, it may require a variety of different treatments or a more complex plan. Some people take a short course of topical antibiotics when blepharitis symptoms flare up (occasionally in conjunction with steroids, but only under a doctor’s supervision). Most patients are able to control their blepharitis symptoms, and the overall prognosis is good. Also keep in mind that if an underlying condition is the cause of your blepharitis, treating that condition is important to your treatment plan. Call your eye care provider for an appointment if symptoms worsen or do not improve after careful cleansing of the eyelids for several days.
Prognosis of Blepharitis
In most cases, symptoms improve with treatment. For most people the condition is chronic, and symptoms may come and go. Symptoms typically recur once treatment stops. Although symptoms have the potential to be severe, blepharitis is rarely considered a serious condition.
It is extremely important that you see your eye doctor at least once a year. Even if you do not have any symptoms, an eye exam is a great opportunity for you and your doctor to find out if anything is wrong, or if you have a condition such as blepharitis. Additional preventive measures you can take include:
- Keeping the area around your eyes clean with daily warm compresses and gentle lid hygiene
- Keeping your scalp clean and free of dandruff
- Treating skin disorders such as rosacea
- Avoiding dusty or smoky environments whenever possible
- Avoiding touching or rubbing your eyes, even after washing your hands
Symptoms of blepharitis should never be ignored. In severe cases, or when left untreated, blepharitis can cause complications such as:
- Dry eyes
- Conjunctivitis (infection of the covering over the white part of the eye)
- Thickening, scarring, or notching of the eyelids
- Loss of eyelashes
- Ulceration of the cornea (the clear part of the front of the eye)
- Scarring and blood vessel growth in the cornea
Talking to Your Eye Doctor
Here are some questions to ask your eye doctor about blepharitis:
- Which over-the-counter cleansers do you recommend to reduce the crusting in my eyelashes and eyelids?
- What can I do to help control my symptoms and prevent flare-ups?
- How long should it take for my symptoms to improve?
- Do you know of a dermatologist or allergist who could help me?
- Do I have signs of skin conditions like rosacea or seborrheic dermatitis?
- Do I need prescription-strength medication?
- How much does medication cost?
- What can I do to reduce my risk of this condition recurring?
In March of 2011, the Internet news magazine Ophthalmology Times published an article about recent advancements in our understanding of posterior blepharitis. Recent studies using spectroscopic methods to characterize the structure and function of the meibomian glands have led to a deeper understanding of the pathophysiology of the condition and the efficacy of its therapeutic strategies. Dr. Gary N. Foulks, the Arthur and Virginia Keeney professor of Ophthalmology at the University of Louisville, said, “Our findings were most striking in demonstrating a correlation between spectroscopic lipid changes and the clinical signs of posterior blepharitis and for showing that treatment with topical azithromycin (AzaSite, Inspire Pharmaceuticals) or low dose oral doxycycline helped to restore the lipid complex to a more normal state, which would help to explain the efficacy of these agents in clinical management of posterior blepharitis.” The article goes on to explain how changes in meibum, the secretion made by the meibomian glands of the eyelid, relate to age, disease, and treatment.
- J. DiGirolamo, MD “The Big Book of Family Eye Care” (Basic Health Publications, 2011) 196
- S. Moore, MD; K. Yoder, MD “Complete Guide to Symptoms, Illness & Surgery” Revised 5th edition (The Berkeley Publishing Group, 2006) 179