What Is Blepharitis? Symptoms & Treatment

a woman holding the bridge of her nose

Blepharitis is ‌considered being one of the most common ocular conditions affecting many people of all ages and is usually characterised by inflammation and reddening of the eyelid, causing it to scale and crust. As a result, people with blepharitis experience ongoing discomfort, burning sensations, excessive tearing, and their eyes will feel red, itchy, and swollen.

Blepharitis is not contagious, although it can be caused by bacterial inflammation from congested meibomian oil glands, at the base of eyelashes, as well as bacterial infections and allergies. In many cases, blepharitis can lead to Meibomian Gland Dysfunction (MGD) and can be the root cause of dry eyes.

Due to the chronic nature of blepharitis, people will often go through periods of aggravation and remission, and even though symptoms can be improved frequently, they can never be eliminated completely. In cases with severe recurrent blepharitis, it can lead to permanent changes in eyelid margin and vision loss, and it is therefore vital to consult a specialist to find the most beneficial protocol for managing this condition.

Blepharitis Symptoms

Blepharitis symptoms are typically more noticeable in the mornings. This happens because eyelids stay closed for a prolonged period of time during sleep and it allows excess oil and debris to accumulate around eyelashes. Due to lack of blinking during sleep and deficiency in tear and oil production, caused by congested meibomian glands, eyelids often become dry, red, itchy and swollen, with noticeable crust and flakes around the eyelash line.
Some of the more common symptoms of blepharitis include:

  • Pain or discomfort  
  • Itchy, dry, red eyes 
  • Flaky, scaly or crusty eyelids 
  • Swelling 
  • Watering eyes 
  • Light sensitivity 
  • Gritty, burning sensation
  • Frequent blinking
  • Misdirected, abnormally growing eyelashes
  • Eyelash loss

It is possible that you do not experience all of these symptoms if you have blepharitis. Some of these symptoms can also overlap those of Dry Eye Disease or other ocular surface inflammation and infection it is therefore important that you get your eyes checked as soon as possible by an eye care professional preferably a dry eye specialist because untreated recurrent blepharitis can lead to corneal infections, ulcers, chronic pink eye (conjunctivitis), stye and even blurred vision, and most importantly constant dry eye symptoms.

Blepharitis Causes and Types

There are two main types of blepharitis:

  • Anterior blepharitis
  • Posterior blepharitis

In anterior blepharitis, the eyelids’ skin and base, including follicles of eyelashes, are affected. It is commonly caused by Staphylococcal infections or seborrheic dermatitis. Blepharitis caused by staphylococcal bacteria can often start in childhood and get carried into adulthood. Other areas of the skin can be also affected by staphylococcal bacteria at the same time. People with compromised immune systems are more susceptible to these infections, however, a healthy person can get affected too. Recurrent blepharitis caused by staphylococcal condition needs to be monitored and managed accordingly, as it requires specific medical treatment.

Blepharitis caused by seborrheic dermatitis leads to less inflammation of the eyelids but results in more excess oil production or greasy scaling. It is commonly associated with eczema caused by abnormal sebum production. People with anterior blepharitis typically experience itchy eyes and a scaly appearance to the eyelids.

In posterior blepharitis, symptoms appear in the inner part of the eyelid. It occurs as a result of meibomian glands dysfunction causing irregular oil production which favours bacterial growth, and as a result creating poor tear quality and leading to redness and irritation symptoms. It is a chronic condition that is commonly associated with rosacea. In some cases, it can be caused by demodex mites.

There is growing evidence suggesting that even though blepharitis is caused mainly by infection, it can be aggravated by other environmental factors, such as contact lens wear, prolonged time spent on the computer, air conditioning, and cold and windy weather. Some evidence suggests that avoiding certain foods can also ease the symptoms of blepharitis, including processed or fried food, white flour and sugar, as it creates a sanctuary for bacterial growth. Consequently, a good, rich in vitamins like Omega-3, healthy diet will benefit any treatment prescribed by your doctor.

As with many health conditions, blepharitis can be intensified by stress and anxiety, especially those patients with compromised immune systems. New research also indicates that patients with hormonal imbalance, as well as allergies, are also highly susceptible to this condition. It is therefore vital to get your eyes examined by an eye specialist and to find the best management program for your condition, depending on the root cause of it. As mentioned previously, due to the chronic nature of blepharitis, patients may experience periods of remission and exacerbation of symptoms, however, it cannot be cured but only managed with the right diagnosis and suitable treatment programme.

How Long Does Blepharitis Last?

Due to the variety of causes for blepharitis, it can be difficult to predict how long you will feel symptoms. If your blepharitis is caused by an infection, a successful course of antibiotic treatment may improve your condition within a few weeks.

For most people, blepharitis is a chronic condition that will require ongoing management throughout their lives. The symptoms may come and go during different periods of time. Over time, these flare-ups may reduce in frequency and severity, however, they cannot be eliminated completely.

To ensure it has a minimal impact on your everyday life, it is important to know how you can manage the condition effectively.

Blepharitis Vs Stye

Styes are another type of common eye condition. Blepharitis can sometimes lead to styes developing. The difference between styes and blepharitis is that a stye is ‌only found on one eye and one oil gland, while blepharitis would generally occur on both eyes and would impact most or all of the eyelash oil glands.

A stye will often begin as a spot or pimple near the eyelash line. A stye appears red and swollen, and it lasts anywhere from a few days to a week. Often, styes will burst and clear up on their own, but for more severe cases, you may need to consult a doctor to get the correct treatment. Good eye hygiene is a crucial way to treat both styes and blepharitis.

Blepharitis Vs Conjunctivitis

Even though blepharitis and conjunctivitis appear very similar, with symptoms of dry, red and itchy eyes, the two conditions are completely different. The key difference is the area of the eye that is affected.

Blepharitis affects the oil glands and eyelashes. While conjunctivitis affects the conjunctiva, a thin layer that covers the white of the eye, sclera. Unlike blepharitis, conjunctivitis can be a contagious eye condition and can be passed from person to person. It is a common issue for children but can affect people of all ages. Blepharitis is generally non-contagious.

For more information, please read our article on Blepharokeratoconjunctivitis.

Blepharitis Treatment

All forms of blepharitis can be diagnosed during your visit to an ophthalmologist and optometrist. Thorough examination under a slit lamp followed by measuring tear production via tear break-up time (TBUT) will be carried out. Specialist eye clinics like the dry eye clinic at Eye Clinic London will perform thorough diagnostics to image the meibomian oil glands, the thickness of the lipid layer of the tear film, and various other complex measurements. Eyelid margin will be examined and the dynamic test is performed to assess how easy the oil can be expressed from the glands and the nature of that oil which can be clear oil (good) or thick waxy (bad) or even blocked meibomian glands.

Once diagnosed, you will be asked to practise good eye hygiene. Hygienic practices include warm compresses using heated eye masks, gentle eyelids massage and sometimes eyelid wash using special eyelid wipes once per day. Using a heated eye mask, place it on your closed eyes for seven to ten minutes. This should be followed by a gentle eyelid massage where you press with your index finger along the eyelid margin creating positive pressure on the eyelid for 3 seconds and then repeated to cover all the lower eyelid. This can be repeated to massage the upper eyelids as well.

Your doctor may recommend medical treatment if regular cleaning is not working or if you have a more severe case. Anti-inflammatory medication could be prescribed in the form of steroid drops if there is no infection present. Occasionally, more innovative treatment might be required. If an infection is present, antibiotics could be prescribed. Always take the medication recommended by your doctor. Ensure you understand how and when to apply or take medication and complete the entire course to ensure successful treatment.

Book A Blepharitis Consultation Today

With any issue affecting the eye, it is crucial to get the proper care. You should always talk to a professional to ensure you get the correct diagnosis and treatment. Here at Eye Clinic London, we are equipped with the latest diagnostics and digital tools to assess eyelid margin disease and have highly specialised experts in the field of dry eye. We are one of the top eye clinics in the world that have an excellent outcome in treating a broad range of eye problems, from cataracts to dry eye disease. Get in touch today to find out more.