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Blepharitis is an inflammatory condition that affects the eyelids, leading to redness, darkening of the lid edges, swelling, and scaliness. Typically, both eyes are affected. This condition commonly arises when small oil glands near the base of the eyelashes become blocked, causing irritation and redness.
There are two types of blepharitis, based on its location on the eyelids:
- Anterior blepharitis: It affects the front exterior of the eyelids, and is characterized by redness or darker coloration, swelling, and the presence of dandruff on the lashes.
- Posterior blepharitis: This occurs when the oil-producing meibomian glands under the eyelid produce thickened or unhealthy oil.
Blepharitis tends to be a chronic condition that can be challenging to treat. While it may cause discomfort and affect the appearance of the eyelids, it typically does not result in permanent damage to eyesight and is not contagious.
Symptoms
Blepharitis signs and symptoms may include:
- Eyelids that are swollen and/or oily
- Eyes that are red and inflamed
- Watery eyes
- Itchy, burning, or stinging sensation in the eyes
- Skin flaking around the eyes
- Crusting of the eyelashes and corners of the eyelids, causing the eyelids to stick together
- More frequent blinking
- Excessive weeping or dry eyes
- Photophobia, or light sensitivity
- Blurred vision that usually improves with blinking
- Lashes are falling out
- Trichiasis, or eyelashes that grow toward the eyes rather than away from them
If you notice that any of the signs and symptoms of blepharitis persist or do not improve despite maintaining good hygiene practices, it is essential to seek advice from a healthcare provider for appropriate intervention.
Causes
Blepharitis may arise due to issues with the meibomian glands responsible for producing the oils in tears, or it could be associated with specific skin disorders or infections. Nonetheless, the precise cause of blepharitis remains unknown.
It could be related to one or more of the following:
- Seborrheic dermatitis: A condition causing dandruff on the scalp and eyebrows.
- Rosacea: This is characterized by facial redness that cause facial skin irritation, which can affect the eyelids
- Allergies: Contact lens solution, eye drops, eye medication, or cosmetics allergies might cause irritation
- Dry eyes: Dry tear ducts can change bacterial resistance, leading to health issues.
- Lice or Demodex mites: These can clog eyelash follicles and glands.
- Meibomian gland dysfunction (MGD): This occurs when the oil from the meibomian glands does not flow freely, resulting in dry eyes, irritation, and infection.
- Infection
Diagnosis
Blepharitis does not have a single definitive test. Instead, your eye care provider may follow these steps to determine if you have blepharitis and identify its specific type:
- Eye examination: The type and severity of blepharitis can be determined by observing the appearance of your eyelids, as well as assessing the intensity of reddening, discharge, and swelling. To aid in this examination, your doctor may use a specialized magnifying instrument to carefully inspect your eyelids and eyes.
- Tear test: A sample of tears can be used to evaluate whether dry eye is a contributing factor.
- Swabbing skin for testing: A swab of eyelid secretion, oil, or crust may be sent to a lab. This sample can be tested for bacteria, fungus, and allergic symptoms. It can determine what type of bacteria is present and in what quantity.
- Eyelid biopsy: In rare cases, a biopsy may be necessary to rule out skin cancer or detect any abnormal cells, as determined by your healthcare provider. During this procedure, your eyelid will be numbed using a local anesthetic, and a needle will be used to extract a sample of cells for microscopic examination. While there may be some bruising, the risk of scarring is minimal.
Treatment
If you suspect you have blepharitis, you can try the following self-care tips to alleviate the symptoms:
- Avoid Eye Makeup: To reduce irritation, refrain from using eye makeup until the inflammation is under control.
- Use Warm Compresses: Begin by taking a clean washcloth and soaking it in comfortably warm water. Make sure to wring out any excess water, and then gently place the cloth over your closed eyelids. For best results, maintain the cloth’s warmth by reapplying as needed. With time, the crusts will soften, making it easier to remove oily debris.
- Use Lid Scrubs: Over-the-counter lid scrubs are available in various forms such as sprays, foams, or individually wrapped towelettes, often containing hypochlorous acid. These scrubs are effective in reducing dandruff on your eyelashes and decreasing bacterial buildup on the skin around your eyes.
Self-care measures are typically effective in managing most cases of blepharitis. However, if self-care proves insufficient, a doctor may recommend prescription treatments, which can include:
- Medications for infection: Topical antibiotics, available in the form of eye drops, creams, or ointments, have demonstrated effectiveness in alleviating symptoms and treating bacterial infections of the eyelids. However, if there is no improvement with the use of these topical treatments, a potential next step recommended by your doctor could be the use of oral antibiotics.
- Medications in controlling inflammation: Steroid eye drops or ointments are commonly employed for this purpose, especially in cases where other therapies have proven ineffective. Doctors may prescribe a combination of antibiotic and anti-inflammatory drugs as an alternative approach.
- Medications affecting immune system: The addition of an immunomodulatory medication like cyclosporine ophthalmic has demonstrated effectiveness in reducing inflammation in cases of posterior blepharitis. These drugs work by inhibiting the body’s natural immune response, leading to a decrease in inflammation.
- Treatments for underlying conditions: Blepharitis can be worsened by skin diseases such as rosacea, or eye problems such as dry eyes. Certain tablets, skin creams, or eye drops for dry eyes may be beneficial in these circumstances. It is critical to address the underlying causes of blepharitis to address symptoms.
- Clinical procedures: Other treatments, such as using powerful pulsed light, may be able to clear the glands. A heat treatment which warms the lids may help release harmful oils.
