Overview

Blepharitis is an inflammatory condition of the eyelids. It can affect people of all ages, but it is more common in older people.

The eyelid margins have eyelashes on their front (anterior) surface. They also have openings of oil glands (Meibomian glands) behind the lashes. 

Types of blepharitis

There are 3 main types of blepharitis. 

Anterior blepharitis

This affects the front of the eyelids, around the eyelashes. It can be due to a bacterial infection. It can also be due to a skin condition called seborrhoeic dermatitis, which is similar to dandruff, and can also affect the scalp, face and ears.

Posterior blepharitis

This mainly affects the back of the eyelids, around the Meibomian glands. It is often linked to the skin condition rosacea, which causes redness of the face.

Mixed anterior and posterior blepharitis

This is a mixture of the types above.

Symptoms of blepharitis

• Crusting, swelling and redness of the eyelids. 
• Tiny flakes on the eyelids, similar to dandruff.
• Dryness of the eye.
• A gritty feeling and burning feeling in the eye.
• Sensitivity to light.
• Blurred vision.
• Loss of eyelashes, or in-growing eyelashes.
• Infections at the root of an eyelash (a stye) on the eyelid.
• Infections and blockage of the Meibomian glands.
• Small ulcers on the eyelids.

Diagnosing blepharitis

In most cases, the diagnosis is made by an ophthalmologist (specialist eye doctor). They will use a microscope, called a slit-lamp, to look at the different parts of the eye.

With blepharitis, the eyelids look red and inflamed, often with crusts and scales around the base of the eyelashes. The Meibomian gland openings might be blocked. The eyelid might have a stye, or a cyst in the Meibomian gland (a small lump called a Chalazia).

The tear film which coats the eye is often uneven. This can be seen by staining the tear film with a yellow dye (fluorescein). Inflammation and loss of skin cells on the surface of your eye (cornea) can also be seen with this staining. 

Treatment

Blepharitis is a long-term condition, and there is no cure. Symptoms can be managed, but it might take some time before treatments are successful.

You can wear your contact lenses and make-up during treatment, but we recommend you keep it to a minimum around the eye.

Your ophthalmologist might recommend the following treatments to help your symptoms.

• Cleaning your eyelids to remove crusts and scales, and unblock the glands. To begin with, you might need to clean your eyelids 2 times a day. In the long-term, you will need to clean them at least 2 or 3 times a week to stop blepharitis from coming back. 
• Artificial tear drops, to treat dryness and help your eye feel more comfortable.
• Mild steroid eye drops help inflammation of the eye. These are only given for a short time, and only under the supervision of your ophthalmologist.
• Cyclosporin eye drops help inflammation, and the need for long-term steroid drops use.
• Anti-yeast shampoo can help if you have a blepharitis linked to the overgrowth of yeast in your skin. Your ophthalmologist can give you more information.
• Omega-3 supplements can help blepharitis symptoms, and eye dryness. You can buy them from a pharmacy or health food shop.
• Gentle face washes and shampoos with tea tree oil can help reduce the population of the demodex mite, which can contribute to someone getting blepharitis.

Antibiotics

Antibiotic eye-drops and ointments, can be used if you have an infection in the eye that has not got better when using the cleaning measures.

Antibiotics are needed for some types of blepharitis. You might have a course of antibiotic drops (such as Azithromycin), or antibiotics tablets (tetracyclines).

Tetracyclines help inflammation and treat infections. However, these medicines are not suitable for everyone. Please let your ophthalmologist know if you have any medical conditions or you are taking any other medicines. This includes anything you buy yourself (such as antacids).   

• You should not take tetracyclines if you are pregnant or breastfeeding
• You cannot expose yourself to lots of sunlight while taking this medicine.
• The medicine can be affected by food and milk. Your ophthalmologist will give you information on how to take them. 
• Taking this medicine long-term has been linked to the failure of oral contraception, but this is rare. You should discuss this possibility with your GP. 

Tell your ophthalmologist if you are allergic to any medicines.

If you do not get treatment

Blepharitis will not go away. It might get worse, and irritate the front surface of your eye (cornea). This could lead to discomfort and infection.

Side effects of treatment

The main side effect of eye drops, ointments and other medicines used to treat your eyes is an allergic reaction or irritation.

Other side effects include:

• redness that gets worse
• sore eyes that gets worse
• increased itchy eyes
• changes to your vision

The side effects are similar to the symptoms of blepharitis. If you think your symptoms are getting worse, contact your nurse practitioner in the eye casualty department. 

Different medicines can be used to treat blepharitis, so it is not possible to list all potential side effects. Please read the information leaflet that comes with your medicine for more information.

Cleaning your eyelids

1. Wash your hands

2. Soak a flannel in warm water (make sure the water is not too hot)

3. Close your eyes and gently press the flannel against them for 10 minutes. This will help to soften any hardened oil secretions.

An alternative to the flannel method is to buy a device called an ’eye bag’, which you can find on the internet. Eye bags can be heated in a microwave, and then placed over your eyes. They release heat more slowly than a flannel, and do not have to be re-soaked in warm water every few minutes to keep them warm.

4. Clean your eyelids. You can do this with a specialised eyelid cleaning pad, or by soaking a cotton bud in cooled boiled water and using this.

5. Gently rub the cotton bud along the edge of your lower eyelid. It can help to tilt the lid outward using a finger from your other hand.

6. Clean the upper eyelid with a cotton bud. The upper eyelid is more difficult to clean. It is best done with the eyelid closed and pulled slightly over your lower lid. This makes sure that you cannot poke yourself in the eye.

7. You can add ointments and drops after you have finished cleaning your eyes.