Blepharitis

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have blepharitis, or who would like information about it.

Blepharitis is inflammation on the edge of the eyelid. It usually affects both eyes and causes irritation and redness. It can affect the inside and the outside of the eyelid.

About blepharitis

Blepharitis is a chronic condition which causes the edges of your eyelid to become red and inflamed. When describing an illness, the term 'chronic' refers to how long a person has it, not to how serious a condition is. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person's life. Blepharitis is a common condition. It can affect people of any age, although it's more common in old age.

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 that lie behind your eyelashes.

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
• scaly or greasy eyelids
• difficulty wearing your contact lenses
• blurred vision

Complications of blepharitis

Blepharitis isn't a serious condition. Your sight is rarely affected, but it 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 you have severe blepharitis for a long time, your eyelashes may fall out, or may grow inwards.
• 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 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, or the quality of your tears isn't good enough to keep your eye evenly wet. It can cause irritation and redness in your eyes.

Causes of blepharitis

There are a number of possible causes of blepharitis and you may have more than one condition affecting your eye.

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

• Staphylococcus 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 most people with blepharitis.
• Seborrhoeic dermatitis. This is a type of eczema. It's caused by an allergy to a yeast on your skin. It can affect the skin on your scalp, eyebrows and ears as well as your eyelids. Seborrhoeic dermatitis that affects your eyelids is called seborrhoeic blepharitis. It causes your skin to look pink and sometimes oily, with yellowish or white flakes.
• 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.
• Eczema. Rarely, blepharitis can be caused by atopic eczema. Atopic eczema is skin condition linked to asthma and hay fever. It causes dry, itchy skin.

Blepharitis that affects the inside of your eyelid 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 the glands produce can change or the glands can block. This means that tears don't spread evenly across your eye, which can cause them to feel gritty and sore. This is called posterior blepharitis. You're more likely to have this condition if you have skin conditions such as rosacea and psoriasis.

Diagnosis of blepharitis

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may refer you to an eye specialist if your:

• condition is severe
• eyes are painful
• vision is blurred
• treatment doesn't work

Treatment for blepharitis

Blepharitis usually 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. It also massages the glands to help clear any blockages.

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

If you have blepharitis inside your eyelid, you can massage 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. 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.

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.

Try to not wear eye make-up because this could make your condition worse or stop it getting better.

Medicines

If your blepharitis is caused by an infection, your GP may prescribe an antibiotic ointment. Apply the antibiotic ointment onto clean skin using a clean finger or a cotton bud. If your symptoms are severe or other treatments don't work, your GP may prescribe antibiotic tablets, such as oxytetracycline or tetracycline. You may need to take antibiotic tablets for between six and 12 weeks. If your blepharitis is caused by an allergic reaction to something, your GP may prescribe a steroid cream. This should help to reduce inflammation on your eyelids.

Blepharitis can cause your eyes to feel very dry (dry eye syndrome).You can treat this using eye drops called artificial tears. To begin with, you should use them hourly throughout the day. You may find you need to use them less often after a week or two. Your GP can prescribe artificial tears 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?

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.