Blepharitis: What It Is, Symptoms & Treatment

What is blepharitis? Could you have this condition?

Blepharitis is a very common and underdiagnosed condition today. It is a chronic inflammation of the eyelids that causes dysfunction of the front surface of the eye, the eyelids, the tear film and the outer layers of the cornea. Blepharitis is often difficult to treat and the symptoms take time to improve.

Page contents

1. What is blepharitis? Could you have this condition?
2. What are the symptoms of blepharitis?
3. Why does it feel like there is something in my eye?
4. What causes blepharitis?
5. What is the right treatment?
6. Home remedies for blepharitis: what helps and what doesn’t
7. Can blepharitis affect the eyes?
8. Types of blepharitis: anterior and posterior
9. Blepharitis and rosacea
10. How blepharitis is diagnosed
11. Step-by-step eyelid hygiene routine
12. In-clinic treatments for persistent blepharitis
13. Blepharitis in children
14. When to see an ophthalmologist
15. Blepharitis, screens and daily habits
16. How quickly will I see results?
17. Frequently Asked Questions about Blepharitis

 

What are the symptoms of blepharitis?

One of the most common symptoms is a foreign body sensation and pain. A foreign body sensation is the feeling that there is a “speck of dust” in the eye that does not go away, or takes a long time to go away, even when we blink.

Stinging or a burning feeling in the eyes is another very common symptom. It usually gets worse as the day goes on and is at its worst in the hours before bed. The more intense the symptoms, the more intense the redness of the eyes (red eyes). Finally, a paradoxical symptom is watering, meaning that the eye produces tears. It is paradoxical because, although the condition leads to dry eye, the patient complains that the eye is watering. The reason for this reaction is that the dryness that develops locally on the cornea leads to the production of more tears than can be drained away.

 

Why does it feel like there is something in my eye?

A foreign body sensation, as if there is sand or grit in the eye, is one of the most common complaints in blepharitis. It is not caused by something that has got into the eye, but by changes at the eyelid margin and in the tear film:

• Unstable tear film. The meibomian glands produce the oily layer that stops tears from evaporating. When they do not work properly, the surface of the eye dries out in patches and becomes irritated.
• Scales and debris at the base of the eyelashes, which rub against the eye with every blink.
• Inflammation of the eyelid margin, which makes its contact with the cornea more uncomfortable.
• Demodex mites, which in some people multiply at the roots of the eyelashes.

The discomfort is usually worse in the morning or after hours in front of a screen, and it often goes hand in hand with dry eye. However, if the sensation came on suddenly in one eye and is accompanied by pain, marked redness, sensitivity to light or blurred vision, there may be a real foreign body or an injury to the cornea, and you need an urgent examination.

What causes blepharitis?

The main cause is dysfunction of the eyelid glands and of the eyelids in general, which produce fewer tears and tears of poor quality. This is often complicated by an increase in the population of a mite called Demodex, which makes the inflammation worse.

Tears themselves have three layers, the most important being the outer one, called the lipid layer. In some people, the production of one of the tear layers is insufficient, so the tear film “breaks up” more easily (in a shorter time). This is also the basis of a test we use to check the tear film and how well it works, called tear break-up time (TBUT). The usual cause of this condition is blepharitis which, as mentioned above, is a chronic inflammation of the eyelid area that leads to its dysfunction. Modern lifestyles, with lots of screen time, air conditioning and air pollution in cities, as well as frequent contact lens wear, all contribute to the development and worsening of blepharitis.

We often see blepharitis causing considerable discomfort in people with coexisting skin problems such as seborrhoeic dermatitis, rosacea, and skin infections or allergies.

What is the right treatment?

The most important point in treating ocular surface disease is to diagnose the exact cause of the problem and, by extension, to break the cycle of eyelid dysfunction, dry eye and excessive tear production.

Fortunately, there are quite a few solutions available for treating this condition.

Depending on the stage and the exact cause, treatment involves one of the following options.

• Eyelid hygiene together with warm compresses at a constant temperature of 40 °C for 10 to 20 minutes (Ophthalmogen EYE10 single-use warm compresses). Another easy way to make a compress is with a clean towel dipped in a bowl of warm water. After wringing it out, we place it over our closed eyes until it cools down and repeat the process for 10 minutes.
• After the warm compresses, eyelid hygiene continues with cleaning, massaging and spraying the eyelids and eyelashes with specialised products available from the pharmacy in the form of gel, spray, foam or wipes (Ophthalmogen gel/spray, Naviblef).
• Treatment with antibiotics. A specific class of antibiotics has been found to improve blepharitis significantly
• Treatment with artificial tears
• Reducing tear drainage slightly, so that tears stay on the eye for longer. This is done by placing small devices called “punctal plugs” in the tear ducts. The procedure takes a few seconds, is completely painless and the cost is particularly low. Another big advantage is that they can be removed just as easily as they are inserted.
• A very effective treatment is carried out with a device called IPL, which has been shown to improve blepharitis significantly, especially when there are coexisting skin conditions. This technique was developed in recent years in the United States and appears to have excellent results. It is completely painless, no eye drops or ointments are needed after treatment, and it takes 15 minutes to complete.
• There is also a specific treatment with drops that increase tear production.

So, depending on the exact cause of your symptoms, we can offer personalised solutions so that your problem is treated quickly and effectively.

Home remedies for blepharitis: what helps and what doesn’t

Blepharitis is usually chronic, and care at home is a key part of treatment. However, not all “natural” measures are equally useful.

What helps

• Warm compresses or a heated eye mask for 5-10 minutes, once or twice a day.
• Daily cleaning of the eyelid margins with special wipes or eyelid hygiene solutions.
• Avoiding make-up along the lash line during a flare-up and cleaning your brushes regularly.
• A diet with oily fish rich in omega-3 and drinking enough water.

What is not recommended

• Chamomile or other herbal tea bags on the eye: they can cause an allergy or infection.
• Essential oils, such as pure tea tree oil, near the eye: they are very irritating. There are special products for the eyelids, which should only be used on medical advice.
• Lemon juice, salt or breast milk in the eye: they have no benefit and carry a risk of infection.
• Steroid or antibiotic eye drops from an old prescription, without an examination.

If the symptoms persist despite good hygiene, or you often get chalazia (eyelid cysts), you need an assessment for in-clinic treatments such as IPL for the eyelids.

Can blepharitis affect the eyes?

In advanced cases, chronic inflammation causes the eyelashes to change direction or fall out. If they turn towards the cornea, they start to scratch it, causing significant symptoms and a condition called trichiasis. Loss of the eyelashes, called madarosis, fortunately causes few or no symptoms.

Flaking and swelling are common eyelid problems in people with chronic blepharitis.

Chalazia: chronic blepharitis is one of the most important factors in developing chalazia, and recurrent ones in particular.

Chronic redness of the eyes: as a result of chronic irritation.

Damage to the cornea: one of the most dangerous complications of blepharitis. It needs prompt and effective treatment to avoid permanent corneal scarring, which would cause a corresponding loss of vision.

Types of blepharitis: anterior and posterior

The term blepharitis describes inflammation of the eyelid margin, but in practice there are two main forms, which often coexist. The distinction matters, because the treatment is not exactly the same.

Anterior blepharitis

This affects the outer edge of the eyelid, where the eyelashes grow. It is characterised by crusts or “dandruff” at the base of the eyelashes, redness and itching. The most common causes are:

• Staphylococcal: overgrowth of bacteria that normally live on the skin. It can cause hard crusts, small ulcerated areas and, in some people, loss of eyelashes.
• Seborrhoeic: linked to seborrhoeic dermatitis of the scalp, eyebrows and face. The crusts are greasier and softer.
• Demodex: microscopic mites that live in the eyelash follicles. In large numbers they cause persistent itching, especially in the morning, and characteristic “collarettes” around the base of the eyelashes.

Posterior blepharitis

This affects the inner edge of the eyelid and the meibomian glands, which produce the oily layer of the tears. When their secretion becomes thick, the glands become blocked, tears evaporate quickly, and burning, blurred vision that clears with blinking, and recurrent chalazia appear. Posterior blepharitis is the most common cause of evaporative dry eye and is often linked to facial rosacea.

Blepharitis and rosacea

Rosacea is a chronic skin condition with redness on the cheeks and nose, visible blood vessels and flushing. In many patients it also affects the eyes, even before the skin signs become visible. Ocular rosacea shows up as marked posterior blepharitis, red eyelids, dryness and sensitivity to light. In these cases, cooperation between the ophthalmologist and the dermatologist helps considerably, because treating the skin also improves the eyes.

How blepharitis is diagnosed

Blepharitis is diagnosed with a slit lamp examination. In the clinic we assess:

• the presence of crusts, “collarettes” or mites at the base of the eyelashes
• the openings of the meibomian glands and the quality of their secretion with gentle pressure
• tear break-up time, that is, how quickly the tear film “breaks up”
• the conjunctiva and the cornea for signs of irritation or damage
• the skin of the face for rosacea or seborrhoeic dermatitis

Based on the findings, we draw up a personalised treatment plan, because blepharitis is controlled much better when we know which form is dominant.

Step-by-step eyelid hygiene routine

Daily care is the foundation of any treatment. We recommend the following simple routine, morning and evening, for at least 4 to 6 weeks, and then less often as maintenance:

1. Warm compress for 5 to 10 minutes: a heated eye mask or a clean towel soaked in warm but not hot water. The heat liquefies the secretion of the glands.
2. Gentle massage: with your eyes closed, press gently with a finger from the base of the eyelid towards the eyelashes, downwards on the upper eyelid and upwards on the lower one.
3. Cleaning the eyelid margin: with special wipes or eyelash foam, clean the base of the eyelashes with horizontal movements, without rubbing the eye.
4. Artificial tears: where there is dryness, we prefer preservative-free products or those with lipid ingredients.

The secret is consistency. Most patients see an improvement after two to three weeks, while symptoms usually come back when the routine stops.

In-clinic treatments for persistent blepharitis

When daily care is not enough, there are treatments carried out by the ophthalmologist:

• Medication: antibiotic ointments on the eyelid margin, short courses of anti-inflammatory eye drops and, in selected cases, low-dose oral antibiotics, which work mainly as anti-inflammatories on the glands. The choice and duration are decided by the doctor.
• Treating Demodex: special eyelid products that reduce the mite population, used over a programme of several weeks.
• In-clinic eyelid cleaning: mechanical removal of crusts and biofilm from the base of the eyelashes, which helps particularly in anterior blepharitis.
• Heat and light therapies: techniques such as intense pulsed light treatment around the eyelids can improve meibomian gland function in patients with posterior blepharitis and rosacea.

Blepharitis in children

Blepharitis does not only affect adults. In children it can appear as recurrent chalazia or styes, red eyelids, sensitivity to light and frequent eye rubbing. In some children the inflammation spreads to the cornea and can affect vision, so an assessment by a paediatric ophthalmologist is needed. Treatment is based on the same hygiene approach, adapted to the child’s age.

When to see an ophthalmologist

• when the symptoms do not improve after 3 weeks of consistent care
• when there is pain, sensitivity to light or reduced vision
• when eyelashes fall out or the shape of the eyelid margin changes
• when blepharitis affects only one eye and does not settle
• before any eye procedure, such as laser or cataract surgery, because blepharitis needs to be under control

Dr. Vasileios Skouteris treats patients with blepharitis and dry eye every day at his clinic in Neo Psychiko, Athens. To book an appointment, call 210 677 0007.

Blepharitis, screens and daily habits

Many patients notice that their symptoms get worse on days with a lot of computer work. This is no coincidence. When we look at a screen, we blink less often and less completely, so the meibomian glands do not empty properly and tears evaporate faster. The result is more burning and red eyes at the end of the day.

A few simple changes help a great deal:

• place your screen slightly below eye level, so that your eyelids cover more of the eye
• make a conscious effort to blink slowly and fully every few minutes
• avoid air from air conditioning or heaters blowing directly on your face
• drink enough water and ventilate the room
• remove your make-up every evening and avoid strongly scented products around the eyes

A diet with enough omega-3 fatty acids, from fish, nuts and olive oil, is generally good for your health. Supplements have shown mixed results in studies on blepharitis, so we discuss them as a supporting option rather than a treatment on their own.

How quickly will I see results?

Blepharitis improves gradually. In the first one to two weeks, crusting and redness usually decrease. Meibomian gland function needs more time to recover, often one to two months. In people with Demodex, treatment lasts at least six weeks, because it has to cover the life cycle of the mites.

It is important not to stop your eyelid care as soon as you feel better. Blepharitis is, as a rule, a chronic condition that can be controlled very well but rarely “disappears” for good. A simple maintenance routine a few times a week keeps the symptoms at bay.

Frequently Asked Questions about Blepharitis

Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO