Blepharitis

About blepharitis

Blepharitis is a non-contagious eye condition that causes the edges of your eyelid to become red and inflamed. Blepharitis is a common condition that affects one in three people in the UK. It can affect people of any age, although it's more likely to affect you if you’re over 50.

There are two types of blepharitis.

  • Anterior blepharitis affects the outside of your eyelid, where your eyelashes are attached.
  • Posterior blepharitis affects the row of tiny glands (meibomian glands) that lie behind your eyelashes.

Blepharitis is a chronic condition that can reoccur; however, treatment can control your symptoms and prevent complications. A chronic illness is one that lasts a long time, sometimes for the rest of your life. When describing an illness, the term ‘chronic’ refers to how long a person has it, not to how serious a condition is.

Symptoms of blepharitis

The symptoms of blepharitis often come and go, getting better or worse over a long period of time. Blepharitis usually affects both eyes and you may find your symptoms are worse in the morning. Your symptoms may include:

  • red, sore eyelids, which may also be swollen
  • a gritty, burning or itching feeling in your eyes
  • eyelids sticking together
  • crusting on your eyelashes
  • difficulty wearing contact lenses
  • blurred vision
  • losing your eyelashes

These symptoms may be caused by problems other than blepharitis. If you have any of these symptoms, see your GP for advice.

Complications of blepharitis

Blepharitis can lead to other problems in and around your eye. Some of the main complications are listed below.

  • A stye. This is a painful swelling on the outside of your eyelid. It's usually caused by an infected eyelash.
  • Eyelash problems. If your blepharitis is severe or you have had it for a long time, your eyelashes may fall out, grow inwards or lose their colour.
  • Conjunctivitis. This is an inflammation of your conjunctiva, the transparent layer that lines your eyelids and covers the white of your eye.
  • Chalazion. This is a pea-sized lump, similar to a stye, which is caused by inflammation of a blocked gland. Occasionally, it can put pressure on your cornea (the front part of your eye that covers the pupil) causing it to change shape (astigmatism).
  • Dry eye syndrome. This is when you don't have enough tears to keep your eyes moist. It can cause feelings of dryness, grittiness and soreness in your eyes.

Causes of blepharitis

Anterior blepharitis affects the outside of your eyelid and can be caused by an infection, a skin condition or an allergy. The main causes are listed below.

  • Staphylococcal infection. The staphylococcal bacteria can cause an infection called staphylococcal blepharitis on the base of your eyelids. This kind of bacteria is found on the eyelids of nine out of 10 people with blepharitis.
  • Seborrhoeic dermatitis. This is a common condition that causes patches of inflamed skin on areas of your face, scalp and body. Your skin may look pink and sometimes oily, with yellowish or white flakes. Seborrhoeic dermatitis that affects your eyelids is called seborrhoeic blepharitis.
  • Allergic or contact dermatitis. This is caused by an allergic reaction to something that is in direct contact with the skin around your eyes, for example, eye make-up or contact lens solution.
  • Rosacea. This is a skin condition that causes a red rash on your face. The skin on your face may be dry and flaky. The skin on your eyelids may look red and feel sore or gritty.

Posterior blepharitis affects the inside of your eyelid and is usually caused by a problem with the meibomian glands behind your eyelashes. These glands make substances that help tears to spread across your eye, keeping it moist. The substances that your meibomian glands produce can change or the glands can get blocked. This means that tears don't spread evenly across your eye, which can cause them to feel gritty and sore. You're more likely to have this condition if you have skin conditions such as rosacea.

Diagnosis of blepharitis

Your GP will ask about your symptoms and examine you. He or she will probably be able to diagnose blepharitis from your symptoms and a physical examination. Your GP may refer you to an eye specialist if your condition is severe.

Treatment for blepharitis

Blepharitis can't be cured, but your symptoms can be controlled. This means that you will probably need to have long-term treatment.

Self-help

It's important to keep your eyelids clean. This will keep them free from flakes of skin and reduce the risk of an infection.

Try putting a warm compress over your eyelids for five to 10 minutes. Use a cloth soaked in warm water to make the compress. The water you use shouldn't be boiling – the compress should feel comfortable on your skin. This will help to loosen any crusting or flakes of skin.

You can clean your eyelid by using a small amount of baby shampoo diluted in water. Apply it with a cotton bud along the edge of your eyelid and rinse with clean water.

You should clean your eyelids and use a hot compress twice a day until your symptoms have gone. You can then do this routine once a day to prevent symptoms coming back.

If you have posterior blepharitis, you can massage the edge of your eyelid by gently rolling your finger in a circular motion around it. You should do this for about a minute. The massage will help to remove any blockages and release trapped fluids. Try to not wear eye make-up because this could make your condition worse or stop it getting better. If you wear contact lenses, you may be more comfortable wearing glasses until your symptoms ease.

Medicines

If your blepharitis is severe or keeping your eyelid clean hasn’t helped, your GP may prescribe an antibiotic ointment. If an antibiotic ointment doesn't work, your GP may prescribe antibiotic tablets although this is uncommon. If you do need to take antibiotic tablets, you will have to take them for between six and 12 weeks.

Blepharitis can cause your eyes to feel very dry (dry eye syndrome).You can treat this using tear replacement eye drops. Your GP can prescribe eye drops or you can buy them from a pharmacy.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Video

See our video about blepharitis:

  • How should I clean & care for my eyelids if I have an infection in them?

Can I still wear my contact lenses if I have blepharitis?

Answer

If you have blepharitis, you may find it difficult to wear your contact lenses.

Explanation

Blepharitis can make your eyes feel very sore and itchy. This often makes it difficult to wear contact lenses. Many people find they can't tolerate contact lenses when they have symptoms.

Treatments for blepharitis include eye ointments or artificial tear drops. If you use an eye ointment that contains paraffin, you should wear glasses instead of contact lenses.

If you wear soft contact lenses, don't use artificial tears that contain preservatives because these will cause irritation. Most eye drops are available without preservatives. Speak to your GP for more information.

How can I prevent blepharitis from coming back?

Answer

Keeping your eyes clean and clear of any crusting or stickiness will help control the symptoms of blepharitis.

Explanation

Blepharitis is a condition that can’t be cured permanently and may flare up from time to time. In order to keep the condition well controlled and to reduce your symptoms it's important you keep the skin on your eyelids clean. This means good hygiene at all times, even when you don't have any symptoms of blepharitis. Good eye hygiene means keeping your eyelids and lashes clean and clear of any crusting or stickiness. Clean your eyelids every day using a cotton bud soaked in warm water and diluted baby shampoo. See our treatment section for more information.

If your symptoms keep coming back despite taking these steps, you should see your GP. He or she may suggest a different treatment or refer you to a specialist.

How is dry eye syndrome treated?

Answer

Dry eye syndrome can be treated using self-help measures, such as good eye hygiene and not smoking. Your GP may also prescribe eye drops.

Explanation

Dry eye syndrome is when you don't have enough tears to keep your eyes moist, or the quality of your tears isn’t good enough to keep your eyes evenly wet. It’s usually caused by another condition, such as blepharitis.

There are a number of self-help measures that may help to ease the symptoms. Some of the main ones are listed below.

  • Don't use any medicines that may make dry eyes worse, such as antihistamines.
  • Don't wear contact lenses.
  • Keep your eyes and eyelids clean to control any blepharitis.
  • Use a humidifier to keep the air around you moist.
  • Don't smoke.
  • If you're using a computer for long periods of time, make sure that the monitor is at or below the level of your eyes. Take breaks from looking at the screen and blink or close your eyes regularly.

If these self-help measures don't work, see your GP for advice. He or she may prescribe eye drops or ointments to keep your eyes moist.