Blepharitis is a common condition that causes inflammation (irritation) of the eyelids.
What causes blepharitis?
Blepharitis is caused when the small glands in the eyelids, which produce oils, become blocked. This causes dry, sore, irritates eyes and eyelids. It is more common is people who have skin conditions like eczema, acne and rosacea.
Blepharitis tends to be a long-term, ongoing condition. Although it can occur at any age, it tends to be more common in older people.
What are the symptoms of blepharitis?
Blepharitis can cause:
- red, sore, swollen eyelids
- itching, irritation, discomfort around the eyes
- dry, burning, gritty eyes
- tiny flakes (like dandruff) at the bottom of the eyelashes.
How is blepharitis treated?
The aim of treatment is to keep the eyelids clean, treat any infection and avoid irritants to the eye. Because blepharitis does not go away completely, regular cleaning of the eyelids is required. This involves applying a warm compress to the eyelid to loosen the crusts, followed by eyelid massage and light cleaning of the eyelid.
- Warm compress: hold cotton facial pads soaked in warm water against your closed eyelids for 5 to minutes. Repeat this twice a day. This helps melt the oils in the blocked glands, allowing the oils to flow more freely.
- Eyelid massage: to massage eyelids, use the tip of your finger firmly stroke the skin of the top eyelids in a circular motion. This will help unblock the oil glands and squeeze out the oils.
- Eyelid cleaning: Make up a solution of baby shampoo (1 part baby shampoo and 10 parts water). Dip a clean cotton bud in the solution and clean away any crusts present on the eyelashes and rub along the eyelids. Use a clean cotton bud for each eyelid. Repeat this process twice a day.
If you have dry eyes, use an eye lubricant such as artificial tears, to keep the eyes moist.
If your eyes become increasingly red or painful, or your sight becomes blurred see your doctor. You may need antibiotic or steroid eyedrops.
While your eyes are irritated and inflamed, avoid using eye makeup such as eye shadow, eyeliner and other cosmetics around the eye. Also avoid using contact lenses should until the condition is under control.
Blepharitis The Royal Australian and New Zealand College of Ophthalmologists
Blepharitis NHS choices
Facts about blepharitis National Eye Institute
- Causes, complications and treatment of a red eye BPAC, August 2013
- Blepharitis The Royal Australian and New Zealand College of Ophthalmologists
Information for health professionals
This page has more detailed information and resources designed for health professionals.
The following information has been adapted from The Auckland Eye Manual.
Blepharitis is a general term for inflammation of the eyelid, but is most commonly used in relation to chronic lid margin disease. The terms anterior blepharitis and posterior blepharitis are used to differentiate the two main types seen. Posterior blepharitis is also referred to as meibomian gland dysfunction and is extremely common, affecting as much as 50% of the population to some degree. There is inflammation of the meibomian glands resulting in a lack of healthy meibomian secretions, which causes dry eye. It is often associated with rosacea. Anterior blepharitis is due to a build-up of lid commensals (mainly staphylococcus) and results in reddened inflamed lid margins.
Burning, especially in the morning. Dryness and irritation. Red lids with crusting and scaling.
- Red lid margins (anterior blepharitis).
- Scales in the lashes, loss of lashes (anterior blepharitis).
- Chalazia (anterior and posterior blepharitis).
- Notching of the lid margin (anterior and posterior blepharitis).
- Inflamed meibomian gland openings, often with thickened secretions in the gland orifice (posterior blepharitis).
The most important treatment is correctly performed lid hygiene. This comprises three steps:
- Heat the lids up for at least 2 minutes (eg, with a hot flannel, or under a hot shower).
- Apply firm pressure directly onto the lids just below the lower lashes and just above the upper lashes. This is to express the contents of the meibomian glands. The patient should not “massage” the lid skin as this merely stretches the lid skin and does not express the glands.
- The lid margins/lashes are then cleaned either with a commercial product, such as Sterilid or Lidcare, or with a solution of baby shampoo on a flannel.
A course of topical antibiotic ointment may help (chloramphenicol qds or fucithalmic bd). Oral doxycycline can significantly help with meibomian gland dysfunction (50mg a day for 3 months).
Ocular lubricants can help symptomatically. It is best to avoid drops containing the preservative benzalkonium chloride; gel type lubricants give the best comfort, although they may blur the vision. Often it is helpful to get the patient to try different types of drop to see which gives them the greatest relief.
In severe cases topical steroids may be used, but only when other treatments have either failed or are not possible (older patients often find lid hygiene impossible).
Blepharitis is a chronic condition that is likely to recurrently plague the patient for life. Symptoms, however, can usually be controlled by continuing treatment as above.
Refer patients to an ophthalmologist if standard treatments are insufficient and if topical steroids are being considered.
Causes, complications and treatment of a red eye BPAC, NZ, 2013
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