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Blepharitis

Definition

Blepharitis is manifest by inflamed, irritated, itchy, and reddened eyelids. It most often occurs where the eyelashes grow. Dandruff-like debris builds up at the base of the eyelashes as well.

Causes

The exact cause of blepharitis is unknown. It is thought to be due to:

• An overgrowth of bacteria.

• A skin mite called Demodex.

• A decrease or breakdown of the normal oils produced by the eyelid.

Blepharitis is more likely to be seen in people with:

• A skin condition called seborrheic dermatitis or seborrhea. This problem may involve the scalp, eyebrows, eyelids, skin behind the ears, and the creases of the nose.

• Allergies that affect the eyelashes (less common).

• Excess growth of the bacteria that are normally found on the skin.

• Rosacea, which is a skin condition that causes a red rash on the face.

Symptoms

Symptoms include:

• Red, irritated eyelids

• Scales that stick to the base of the eyelashes

• Burning feeling in the eyelids

• Crusting, itching and swelling of the eyelids

You may feel like you have sand or dust in your eye when you blink. Sometimes, the eyelashes may fall out. The eyelids may become scarred if the condition continues long-term.

Exams and Tests

The health care provider can most often make the diagnosis by looking at the eyelids during an eye exam. Special photos of the glands that produce oil for the eyelids can be taken to see if they are healthy or not.

Treatment

Cleaning the edges of the eyelid every day will help remove excess bacteria and oil. Your provider might recommend using baby shampoo or special cleansers. Using an antibiotic ointment on the eyelid or taking antibiotic pills may help treat the problem. It may also help to take fish oil supplements.

If you have blepharitis:

• Apply warm compresses to your eyes for 5 minutes, at least 2 times per day.

• After the warm compresses, gently rub a solution of warm water and no-tears baby shampoo along your eyelid, where the lash meets the lid, using a cotton swab.

A device has recently been developed that can warm and massage the eyelids to increase the flow of oil from the glands. The role of this device in treatment of blepharitis remains unclear.

A medicine containing hypochlorous acid, which is sprayed onto the eyelids is helpful in certain cases of blepharitis, especially when rosacea is also present.

If Demodex is suspected as the cause, tea tree oil applied to the lids by your provider can be helpful; a new prescription medicine has recently become available. The medicine is lotilaner ophthalmic solution.

Outlook (Prognosis)

The outcome is most often good with treatment. You may need to keep the eyelids clean to prevent the problem from coming back. Continuing treatment will ease redness and help make your eyes more comfortable.

Styes and chalazia are more common in people with blepharitis.

When to Contact a Medical Professional

Contact your provider if symptoms get worse or do not improve after several days of carefully cleaning your eyelids.

Prevention

Cleaning the eyelids carefully will help reduce the chances of getting blepharitis. Treat skin conditions that may add to the problem.

References

Ayres BD, Donnenfeld E, Farid M, et al. Clinical diagnosis and management of Demodex blepharitis: the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). Eye. 2023:37(15):3249-55. PMID: 36964261 pubmed.ncbi.nlm.nih.gov/36964261/.

Cioffi GA, Liebmann JM. Diseases of the visual system. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 391.

Gadaria-Rathod N, Fernandez KB, Isteitiya J, Ashe SA, Asbell PA. Blepharitis. In: Yanoff M, Duker JS, eds. Ophthalmology. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 4.4.

Review Date: 8/5/2024

Reviewed By: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.