What is Blepharitis?

Blepharitis is a common condition characterized by red, inflamed eyelids.  Itching and flaking of the eyelids are also often associated with blepharitis.

What Causes Blepharitis?

Anterior blepharitis affects the outside front of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus) and scalp dandruff.

Posterior blepharitis (also called Meibomitis) affects the inner eyelid (the moist part that makes contact with the eye) and is caused by problems with the oil (meibomian) glands in this part of the eyelid.  The meibomian glands become infected, usually by Staphylococcus bacteria.  Two skin disorders can also cause this form of blepharitis: acne rosacea, which leads to red, inflamed skin and scalp dandruff (seborrheic dermatitis).

What are the Symptoms of Blepharitis?

Symptoms of either form of blepharitis include a foreign body or burning sensation, excessive tearing, itching (usually at the lid margins), sensitivity to light (photophobia, red and swollen eyelids, redness of the eye, blurred vision, frothy tears, dry eye, or crusting of the eyelashes upon awakening.

What Other Conditions are Associated With Blepharitis

Stye: A red tender bump on the eyelid that is caused by an acute infection of an oil (meibomian) gland.

Chalazion: This condition can follow the development of a stye.  It is a usually painless firm lump caused by the leftover inflammatory products of a stye.

Problems with the tear film: Abnormal or decreased oil secretions that are part of the tear film can result in excess tearing or dry eye.  Because tears are necessary to keep the cornea healthy, tear film problems can make people more at risk for corneal infections.

Rosacea: If we find that acne rosacea is contributing to your blepharitis we may also prescribe oral antibiotics in addition to the lid treatments.

How is Blepharitis Treated

Treatment for both forms of blepharitis involves keeping the lids clean and free of crusts.  Warm compresses should be applied to the lid to loosen the crusts, followed by a light scrubbing of the eyelid with a cotton swab and a mixture of water and baby shampoo.  Because this is a chronic condition that rarely goes away completely, most patients must maintain an eyelid hygiene routine for life.  You may notice a significant improvement in 3-5 days; however, continue the treatment for the prescribed time otherwise your symptoms will likely return.

Anterior Blepharitis

1. SOFTEN eyelash crustiness with a very warm washcloth – placing it over your eyes for 5 minutes. There are 3 methods for performing lid scrubs.

• Method A:  Wrap a wet, warm washcloth around your finger. Dip washcloth in no-tears baby shampoo.
• Method B:  Dilute 3 drops of no-tears shampoo with 1 ounce of very warm water.  Moisten a cotton-tipped applicator with the mixture.
• Method C:  Use pre-moistened lid scrub preparation.

2. SCRUB the lids at the base of the eyelashes – scrub both the upper and lower lids.

3. RINSE the eyelids and face with warm, clear water.

Perform lid scrubs two to three times a day for one month.   Once control is achieved a maintenance schedule of once a day will usually keep blepharitis in check.  Often, we will prescribe an ointment or drops to use after you have done the lid scrubs.  If an ointment is prescribed place some on your finger or cotton-tipped applicator and smear it onto the base of both the upper and lower eyelashes.  When scalp dandruff is present, a dandruff shampoo for the hair may also be prescribed.

Posterior Blepharitis / Meibomitis / Stye

In the case of Meibomitis, warm moist heat followed by massaging your lid margins will bring the condition under control.  The following method is recommended.

The image to the left shows a capped meibomian gland which is evidence of advanced meibomian gland dysfunction.

1. APPLY warm compresses to the lids for 10 minutes

• Fill a bowl with warm water from the hot water faucet (as hot as you can tolerate, without burning the skin).
• Place a washcloth in the bowl wring it out and place the washcloth on the eye.
• It is important to keep the temperature high during the 10 minutes, therefore, repeat step two above every couple of minutes.

2. SCRUB your lids using the technique above for anterior blepharitis  (If you have been diagnosed with a stye, do not apply pressure.   Skip the pressure step and proceed to rinse your lid margins)

3. APPLY PRESSURE to the upper and lower lid margins following the compresses.

• Trap the lid between your finger and the white part of your eye, making sure that the upper lid margin does not roll out, apply pressure to the lid, squeezing the eyelid between your finger and the white part of the eye.
• Repeat step one all along the upper and lower lids.  You may notice a milky white material extrude to the surface.   This is what we want.  The milky white “stuff” is the infected material coming to the surface.

4. RINSE your eyelids and face with warm, clear water.

Portions of this document were adapted, with permission, from the National Eye Institute document Facts about Blepharitis.