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Blepharitis: How To Get Rid Of Sore, Red Eyelids

Are you both­ered by sore, red eye­lids — per­haps accom­pa­nied by crusty debris at the base of your eye­lash­es? If so, it’s like­ly you have ble­phar­i­tis.

Here’s what you should know about ble­phar­i­tis, includ­ing how to get rid of it and keep it from com­ing back.

What Is Blepharitis?

Ble­phar­i­tis is inflam­ma­tion of the eye­lid mar­gin. It’s com­mon and treat­able.

There are sev­er­al pos­si­ble caus­es of ble­phar­i­tis, includ­ing:

  • Bac­te­r­i­al eye­lid infec­tion
  • Mei­bo­mi­an gland dys­func­tion (MGD)
  • Dry eyes
  • Fun­gal eye­lid infec­tion
  • Par­a­sites (Demod­ex eye­lash mites)

Some eye doc­tors believe ble­phar­i­tis actu­al­ly is a pre­cur­sor of mei­bo­mi­an gland dys­func­tion and dry eyes, rather than being caused by these con­di­tions. (See “Ble­phar­i­tis And Dry Eyes” below.)

Ble­phar­i­tis also is fre­quent­ly asso­ci­at­ed with skin con­di­tions such as ocu­lar rosacea, seb­or­rhe­ic der­mati­tis and pso­ri­a­sis. Often, ble­phar­i­tis and pink eye occur at the same time.

The most com­mon symp­toms of ble­phar­i­tis are:

  • Burn­ing or sting­ing eyes
  • Crusty debris or dan­druff at the base of eye­lash­es
  • Irri­tat­ed, watery eyes
  • Itchy eye­lids (caus­ing eye rub­bing)
  • Grit­ti­ness or a for­eign body sen­sa­tion


Depend­ing on the sever­i­ty of ble­phar­i­tis, you may have some or all of these symp­toms, which may be inter­mit­tent or con­stant. In some cas­es, ble­phar­i­tis also caus­es loss of eye­lash­es (madaro­sis).

Ble­phar­i­tis is a com­mon cause of con­tact lens dis­com­fort, forc­ing many peo­ple to give up wear­ing con­tacts.

Blepharitis And Dry Eyes

Ble­phar­i­tis and dry eyes often occur at the same time. This hap­pens so often that some researchers and eye doc­tors now believe these two con­di­tions actu­al­ly are parts of a sin­gle chron­ic eye dis­ease process. The name that has been pro­posed to describe this uni­fied con­di­tion is dry eye ble­phar­i­tis syn­drome (DEBS).

Accord­ing to sup­port­ers of the DEBS the­o­ry, dry eye is sim­ply the late man­i­fes­ta­tion of ble­phar­i­tis, and treat­ing ble­phar­i­tis also will pre­vent, reduce or elim­i­nate dry eye symp­toms.

Ble­phar­i­tis is typ­i­cal­ly caused by over­growth of bac­te­ria that live along the mar­gins of the eye­lids and at the base of the eye­lash­es. Over time, these bac­te­ria build up and cre­ate a struc­ture called a biofilm.

This biofilm becomes a tox­ic envi­ron­ment — like the plaque that forms on your teeth. Its con­tents are a food source for par­a­sitic eye­lash mites (Demod­ex fol­licu­lo­rum and Demod­ex bre­vis). Pro­lif­er­a­tion of Demod­ex mites increas­es the irri­ta­tion and inflam­ma­tion of the eye­lids.

Bac­te­ria in the eye­lid biofilm also pro­duce sub­stances caused exo­tox­ins that cause inflam­ma­tion of mei­bo­mi­an glands in the eye­lid mar­gins. These glands nor­mal­ly secrete oils that are impor­tant for a healthy lay­er of tears on the sur­face of the eye. Inflam­ma­tion of mei­bo­mi­an glands affects the qual­i­ty and quan­ti­ty of tears on the eye.

And because our tears con­tain nat­ur­al anti­bod­ies, few­er tears on the eye means even more bac­te­ria grow in the eye­lid biofilm. This wors­ens inflam­ma­tion, even­tu­al­ly lead­ing to mal­func­tion of the mei­bo­mi­an glands (MGD) and prob­lems with oth­er tear glands in and near the eye­lids. These changes led to chron­ic dry eye dis­com­fort.

Clogged mei­bo­mi­an glands also can cause the for­ma­tion of a stye at the lid mar­gin or a cha­lazion with­in the eye­lid.

Blepharitis Treatment

Treat­ment of ble­phar­i­tis should begin with a vis­it with your eye doc­tor to deter­mine the cause of your sore, red, itchy eye­lids. Your doc­tor will close­ly exam­ine your eyes and eye­lids to eval­u­ate whether you have ble­phar­i­tis and what type of treat­ment is most appro­pri­ate.

Typ­i­cal­ly, ble­phar­i­tis treat­ment includes:

Eye­lid scrubs. Remov­ing the buildup of biofilm and excess bac­te­ria from the lid mar­gins is essen­tial for suc­cess­ful ble­phar­i­tis treat­ment. Your eye doc­tor typ­i­cal­ly will rec­om­mend a dai­ly reg­i­men of warm com­press­es and lid scrubs to clean your eye­lids and reduce the amount of bac­te­ria and Demod­ex mites on your lids. Clean­ing agents may include pre­scrip­tion eye­lid cleansers (Aven­o­va), non-pre­scrip­tion eye­lid cleans­ing pads (Ocu­soft; Sys­tane), or dilut­ed baby sham­poo.
In-office pro­ce­dures. Though eye­lid scrubs at home are help­ful, in-office eye­lid hygiene pro­ce­dures often are rec­om­mend­ed for more effec­tive ble­phar­i­tis treat­ment. Pos­si­ble pro­ce­dures include:

1. Electro­mechan­i­cal lid mar­gin debride­ment (Ble­phEx) to effi­cient­ly remove bac­te­ria, biofilm and Demod­ex mites from your eye­lids and open clogged mei­bo­mi­an glands.

2. Ther­mal pul­sa­tion treat­ment (Lip­i­flow) to melt and express mate­r­i­al obstruct­ing the mei­bo­mi­an glands.

3. Intense pulsed light (IPL) ther­a­py to open clogged eye­lid glands and resume nor­mal flow of oils into the tear film.
Med­icat­ed eye drops and/or oint­ments. Your doc­tor also may pre­scribe top­i­cal med­i­cines to destroy excess ble­phar­i­tis-caus­ing bac­te­ria or oth­er microbes on the eye­lids — par­tic­u­lar­ly if there is a risk of eye infec­tion or it appears you have pink eye or some oth­er type of eye infec­tion as well as ble­phar­i­tis.

Eyelid Hygiene Tips

Eye­lid hygiene is very help­ful to treat and con­trol ble­phar­i­tis, but only if per­formed prop­er­ly.

To begin, use a clean, warm com­press to melt any blocked residue in the oil-secret­ing mei­bo­mi­an glands in your eye­lids. Here’s how:

  • Wash your hands, then damp­en a clean wash­cloth with warm (near­ly hot) water.
  • Place the wash­cloth over your closed eye­lids for sev­er­al min­utes.
  • Then gen­tly rub your eye­lid mar­gin with the wash­cloth before open­ing your eyes. (Don’t press hard on your eye.)

Fol­low your eye doctor’s rec­om­men­da­tions on how often to use a warm com­press and how long to keep it in place. When you first begin treat­ment, you may be instruct­ed to do this sev­er­al times dai­ly, for about five min­utes each time. Lat­er on, you might only need to apply the com­press once dai­ly.

Clean­ing your eye­lids is the next essen­tial step. Your doc­tor will rec­om­mend what to use for the clean­ing agent. Options include warm water, dilut­ed baby sham­poo or an over-the-counter or pre­scrip­tion eye­lid cleanser.

To clean your eye­lids:

  • Wash your hands, then moist­en a clean wash­cloth, cot­ton swab or gauze pad with the clean­ing solu­tion.
  • Gen­tly wipe your eye­lash­es and lid mar­gin.
  • Rinse with warm water.
  • Repeat the process for your oth­er eye, using a dif­fer­ent wash­cloth, swab or pad.
  • Your eye doc­tor may have you clean your eye­lids sev­er­al times dai­ly to start, and then once dai­ly there­after.

It’s a good idea to min­i­mize use of eye make­up when you have ble­phar­i­tis, because mas­cara and oth­er make­up can inter­fere with eye­lid hygiene.

If your doc­tor rec­om­mends an anti-dan­druff sham­poo for your scalp and eye­brows, make sure you keep the sham­poo out of your eyes to avoid irri­ta­tion.

How To Keep Blepharitis From Coming Back

Ble­phar­i­tis typ­i­cal­ly is a chron­ic con­di­tion, mean­ing it can come back fre­quent­ly and be a recur­ring prob­lem.

The best way to avoid ble­phar­i­tis or keep it from com­ing back is to clean your eye­lids dai­ly to pre­vent the buildup of bac­te­ria, biofilm and Demod­ex mites on the eye­lid mar­gin. A num­ber of non-prescip­tion lid scrub prod­ucts are avail­able, or you can use the same eye­lid hygiene tech­niques described above.

There also are a num­ber of pre­scrip­tion eye­lid cleans­ing prod­ucts that may be more effec­tive than baby sham­poo or over-the-counter prod­ucts.

Your doc­tor also might rec­om­mend nutri­tion­al sup­ple­ments like omega-3 fat­ty acids to help keep your mei­bo­mi­an glands healthy and your eyes moist and com­fort­able.

If it appears you have an under­ly­ing dry eye prob­lem that may increase your risk of ble­phar­i­tis, in-office inser­tion of punc­tal plugs in the tear drainage chan­nels of your eye­lids may be rec­om­mend­ed. This is a sim­ple pro­ce­dure that has been proven to increase the vol­ume of tears on the sur­face of the eye and decrease dry eye symp­toms.

Rou­tine use of over-the-counter or pre­scrip­tion lubri­cat­ing eye drops also may be rec­om­mend­ed.

Your eye doc­tor also might sug­gest rou­tine in-office eye­lid clean­ing pro­ce­dures to main­tain healthy eyes and eye­lids — just as your den­tist rec­om­mends rou­tine clean­ings to keep your teeth and gums healthy.

Ask your eye doc­tor which eye­lid health main­te­nance pro­gram is best for you. And if ble­phar­i­tis symp­toms return, see your doc­tor imme­di­ate­ly for an eval­u­a­tion.

If You Wear Contacts Or Glasses

If you devel­op ble­phar­i­tis while wear­ing con­tact lens­es, you should dis­con­tin­ue wear­ing your con­tacts until the ble­phar­i­tis has been suc­cess­ful­ly treat­ed. Wear­ing con­tacts when you have eye­lid inflam­ma­tion can result in bac­te­ria and oth­er debris stick­ing to your lens­es and caus­ing pink eye or poten­tial­ly more seri­ous eye dis­eases.

If you don’t have a back­up pair of glass­es and need to pur­chase them, con­sid­er ask­ing for pho­tochromic lens­es, which dark­en auto­mat­i­cal­ly in sun­light and light­en indoors. If you’re like some peo­ple with dry eye who expe­ri­ence light sen­si­tiv­i­ty (pho­to­pho­bia), your eyes may be more com­fort­able out­side with pho­tochromics. Anoth­er advan­tage: you wouldn’t need a sep­a­rate pair of pre­scrip­tion sun­glass­es for out­door wear.

After your ble­phar­i­tis has been suc­cess­ful­ly treat­ed, you can resume wear­ing con­tacts if that’s your pref­er­ence. If you cur­rent­ly wear reusable con­tact lens­es, con­sid­er switch­ing to dai­ly dis­pos­able con­tacts or gas per­me­able con­tacts, which may have a low­er risk of ble­phar­i­tis-relat­ed prob­lems.


July 10th, 2017|Comments Off on Blepharitis: How To Get Rid Of Sore, Red Eyelids

About the Author:

Born in Connecticut and raised in Upstate New York , Dr. Stetson graduated Cum Laude from Colgate University in New York, and then earned an MD degree with honors at the University of Vermont College of Medicine. He distinguished himself again in residency at the Albany Medical Center, where he obtained the highest percentile in the Ophthalmology Knowledge Assessment Examinations. Dr. Stetson has performed more than 50,000 refractive surgeries and has been on staff at Diamond Vision since 2004, before becoming Medical Director in 2006.


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