According to Mina Massaro-Giordano, MD, ophthalmologist and codirector of Penn Dry Eye and Ocular Surface Center at Penn Medicine in Philadelphia, blepharitis can be divided into two types: anterior blepharitis and posterior blepharitis.
“Anterior blepharitis tends to affect more the lash line, where your eyelashes attach to your eyelid. Posterior blepharitis affects the water line of the eyelids, which is the line of skin between the eyelashes and the eye,” Dr. Massaro-Giordano says.
Signs and Symptoms of Blepharitis
Red, thickened eyelids and crusty eyelashes are two signs of blepharitis, says Massaro-Giordano.
Dry eye is another symptom of blepharitis, though this isn’t your typical dry eye, she says. “It’s caused when the meibomian glands of your eye produce an abnormal oil that doesn’t coat the tears the way it should. This causes a quicker evaporation of tears, and the oil that seeps out of the lid doesn’t seep onto the surface of the eye,” she explains.
Additional symptoms of blepharitis include the following:
- Foreign body sensation, which is when it feels like there’s something in your eye
- Burning, stinging, or watery eyes
- Sensitivity to light
- Tears that are foamy or contain small bubbles
More severe symptoms of blepharitis can include blurry vision, eyelashes that grow in the wrong direction or fall out, and swelling in other parts of the eye, such as the cornea.
Causes and Risk Factors of Blepharitis
Anterior blepharitis is often caused either by bacteria, called Staphylococcal blepharitis, or by dandruff of the scalp and eyebrows, known as seborrheic blepharitis. These bacteria are commonly found on the face and eyelids, but an infection may occur if they become excessive or if the lid area has a reaction to them.
The condition can also occur as a result of dandruff or rosacea, which is a skin condition in which people have red cheeks with abnormal blood vessels on their face, Massaro-Giordano says. “Many times, those abnormal blood vessels can be seen on the rims of the eyelid,” she adds.
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“There’s also a type of blepharitis caused by mites in their eyelids called demodex blepharitis,” says Massaro-Giordano.
Herpes simplex virus, the same virus that causes cold sores, can be a cause of blepharitis.
How Is Blepharitis Diagnosed?
Blepharitis is a clinical diagnosis based on the irritation of the eyelids, with crusting and flaking of the lashes. A clinical diagnosis means a doctor determines whether you have a condition by examining you and your symptoms rather than by performing a diagnostic test.
“Many times, patients go to an ophthalmologist's office and think that we’re looking just at the eyeball, but it is necessary to look at the eyelid, lash line, water line, and underneath the eyelid. If the eye doctor doesn’t spend sufficient time examining the lid, the diagnosis can be missed,” says Massaro-Giordano.
There are telltale signs that your doctor can look for on the lids to make a diagnosis of blepharitis, she says. “The lids will be thickened, red, and we look at the eyelashes and see if there is crust hanging out around the eyelashes,” she explains.
Other signs can be found along the water line of the eyelid. “We look at the meibomian glands that are along the water line of the eyelid to see if they’re clogged up,” says Massaro-Giordano.
If mites are suspected to be the cause of blepharitis, a lash can be pulled out and examined under a microscope, she says.
Sometimes patients with itchiness due to blepharitis may incorrectly believe they have allergies. “These people often try to treat with allergy drops, and that can make the dry eye situation even worse,” she says.
“Depending on the type of blepharitis you have, the treatment may vary, which is one of the reasons it’s a good idea to get an ophthalmologist to look at your lids if you’re having symptoms,” says Massaro-Giordano.
Prognosis of Blepharitis
Blepharitis isn’t something that completely goes away, says Massaro-Giordano. “You have to live with it; it waxes and wanes. The prognosis is very good, but it has to managed,” she says.
Unfortunately, it can be set off rather easily with an allergen or exposure to a chemical, she adds.
Duration of Blepharitis
Typically, a mild flare-up of blepharitis will start to get better in a week or so with treatment, says Massaro-Giordano. More severe cases may take longer — sometimes weeks or even a couple months.
Treatment and Medication Options for Blepharitis
For many people with blepharitis, a warm compress and washing the eye and eye area can effectively treat a flare-up of blepharitis, says Massaro-Giordano. “There are microwavable masks that you place on the eyes that can help encourage the oil glands to open up and release all that backed-up oil, she says. A cloth run under warm water and wrung out can also be used.
Follow that by cleaning the area with a moistened towelette designed to clean the eyes or with a gentle soap, such as baby shampoo. Gently clean along the lash line and then rinse, says Massaro-Giordano.
Antibiotics Your doctor may prescribe prescription antibiotic ointment for your eyelid or antibiotic eye drops to treat the bacterial infection and help reduce irritation.
Anti-Inflammatories Steroid drops or creams can be used along with antibiotics to help tamp down inflammation.
Immunomodulators An immunomodulatory drug may be used to treat posterior blepharitis. It works by blocking the body’s natural immune response, which can help reduce inflammation.
Treating Any Underlying Condition If it’s determined that blepharitis is being caused by another condition, such as dandruff or rosacea, treating those conditions can help improve blepharitis.
Alternative and Complementary Therapies
There isn’t any evidence that a specific diet can help treat or reduce the risk of blepharitis, but in general, anti-inflammatory diets can help reduce inflammation in the body, which could be helpful, says Massaro-Giordano.
Fish oil supplements may help improve the quality of the oil from the meibomian glands of your eye or decrease inflammation, she says. “The literature on whether or not it helps is divided. I will always try fish oil on patients; if they can tolerate it and afford it, they might be a person who can benefit from it,” she says.
Prevention of Blepharitis
The best way to keep blepharitis at bay is by cleaning your eyes and eyelids each night, says Massaro-Giordano. “Consider it another habit, like flossing your teeth. You don’t see the plaque growing, but you floss your teeth to keep them healthy. The same goes for keeping your eyes, eyelids, and lashes free of debris,” she says.
People who wear eye makeup need to take extra steps to keep their eyes clean, says Nicole Bajic, MD, an ophthalmologist at the Cleveland Clinic.
To make sure you remove the makeup every night before bed, a double cleansing method may work best, Dr. Bajic says. “First use makeup remover, followed by your preferred facial cleanser,” she says.
RELATED: 8 Rules for Washing Your Face: Dermatologist Dos and Don’ts
Complications of Blepharitis
When blepharitis goes untreated, complications can result.
Hordeolum, or Stye Not everyone is prone to getting a stye, but it can be a consequence of untreated blepharitis, says Massaro-Giordano. "If one of the oil glands along the water line gets infected, a hordeolum, or stye, can occur," she says.
In most cases, warm compresses or an antibiotic and steroid can treat it, she notes. If it isn’t treated or doesn’t go away with treatment, it may heal with a scar that has to be surgically removed, she adds.
Corneal Damage or Scarring Very rarely, if severe blepharitis goes untreated for a long time, the inflammation in the lids could inflame the surface and cause corneal damage or scarring, says Massaro-Giordano.
Research and Statistics: How Many People Have Blepharitis?
A survey of ophthalmologists and optometrists reported that close to half of patients who go the eye doctor show some symptoms of blepharitis.
Blepharitis is more common in older people, and it’s a little more common in women because of the hormonal component, says Massaro-Giordano.
Racial and Ethnic Differences in Blepharitis Prevalence
Blepharitis and meibomian gland dysfunction is more prevalent in the Asian population compared with other groups, says Massaro-Giordano.
Conditions Related to Blepharitis
Other eye conditions may resemble blepharitis or arise from similar causes.
This condition often develops in people with rosacea, a chronic inflammatory disease that causes recurrent flushing, redness, telangiectasia (the presence of visible small, spidery capillaries) and papules on the cheeks, nose, chin, and forehead.
RELATED: Is This Rosacea or Do I Have Something Else?
Resources We Love
American Academy of Ophthalmology
This professional association of eye doctors and surgeons has as their mission to protect sight and empower lives through patient advocacy, education, and advancing the profession of ophthalmology. The association provides information for patients about astigmatism as well as other eye conditions and diseases on EyeSmart.
This program of the American Academy of Ophthalmology offers free eye exams for eligible people over age 65 or those who are at risk for glaucoma.
The NEI was first established by Congress to protect and prolong the vision of the American people. The NEI supports eye disease research through grants and training. It also offers information about eye health for adults and children.