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.
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.