Blepharitis

Page last reviewed: 13/07/2011

Blepharitis is a condition where the rims of the eyelids become inflamed (red and swollen), which can result in symptoms such as:

  • burning, soreness or stinging in the eyes
  • crusty eyelashes
  • itchy eyelids

Blepharitis can be caused by a bacterial infection, or it can be a complication of a skin condition such as:

  • seborrhoeic dermatitis, which causes an itchy rash on the skin and scalp (seborrhoeic dermatitis that affects the scalp is called dandruff)
  • rosacea, which causes the face to appear red and blotchy

It is not possible to catch blepharitis from someone else who has it.

How common is blepharitis?

Blepharitis is responsible for an estimated 1 in 20 eye problems reported to GPs. It is more common in people over 50, although it can develop at any age.

Up to half of people whose blepharitis is caused by staphylococcus bacteria also have dry eye syndrome (a condition where the eyes do not produce enough tears or dry out too quickly).

See Blepharitis - complications for more information about dry eye syndrome in relation to blepharitis.

Outlook

Blepharitis is a chronic (long-term) condition, which means that once it develops it can cause repeated episodes. There is no cure for blepharitis, but establishing a daily eye-cleaning routine can help control the symptoms (see Blepharitis - treatment). This will need to be continued indefinitely. More severe cases of blepharitis may require antibiotics.

Blepharitis is not usually serious. The most common complication is being unable to wear contact lenses while experiencing symptoms. Serious complications, such as sight loss, are rare, particularly if the recommended advice is followed.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi.

Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some are good for you.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

Most people who have blepharitis will experience repeated episodes followed by long periods of time where they do not have any symptoms. Both eyes are affected by blepharitis.

The symptoms of blepharitis can vary depending on what is causing it. The symptoms tend to be worse in the morning and can include:

  • itchy, sore, red eyelids
  • eyelids that stick together and may make it difficult to open your eyes when you wake up
  • eyelashes that become crusty, or oily and greasy
  • a burning, gritty sensation in your eyes
  • increased sensitivity to light (photophobia)
  • abnormal eyelash growth
  • loss of eyelashes
  • swollen eyelid margins (the edges of your eyelids)

Symptoms of other conditions

Blepharitis is often caused by another health condition, which may cause other symptoms as well (see Blepharitis - causes).

If you have blepharitis that is caused by seborrhoeic dermatitis (a skin condition that causes your skin to become inflamed or flaky), you may also have:

  • oily skin
  • dandruff

If you have blepahritis that is caused by rosacea (a skin condition that mainly affects the face), you may also have:

  • flushing (redness)
  • spots

Blepharitis is often associated with another condition called dry eye syndrome (an eye condition where the eyes do not make enough tears, or the tears evaporate too quickly). In some cases, up to half of people with blepharitis will also have dry eye syndrome.

Dry eye syndrome causes:

  • feelings of dryness, grittiness or soreness in your eyes, which gets worse throughout the day
  • redness of your eyes  
  • watering eyes, particularly when you are exposed to wind

Page last reviewed: 13/07/2011

Blepharitis is inflammation (redness and swelling) along the edge of your eyelids. There are two types of blepharitis:

  • anterior blepharitis, when the inflammation affects the outside front edge of your eyelids, where your eyelashes are attached
  • posterior blepharitis, when the inflammation affects your Meibomian glands (which are on the inside front edge of your eyelids and produce a fatty liquid that protects your eyes)      

Sometimes, people will experience both types of blepharitis because the causes are often connected.

Anterior blepharitis

Many cases of anterior blepharitis are caused by a bacterial infection, usually a staphylococcal infection that is caused by the staphylococcus bacteria. Blepharitis that is caused by this type of bacteria is often known as staphylococcal blepharitis.

Anterior blepharitis can also occur as a complication of seborrhoeic dermatitis (a skin condition that causes your skin to become inflamed or flaky). As seborrhoeic dermatitis is known to cause oily skin, it is thought that the excess oil can irritate the eyelids, providing a breeding ground for bacteria.

Blepharitis that is caused by seborrhoeic dermatitis is often referred to as seborrhoeic blepharitis. It often occurs with posterior blepharitis as well.

Posterior blepharitis

Posterior blepharitis is caused when something affects the Meibomian glands that are found on the rim of your eyelids. These glands are responsible for producing an oily substance that makes up the top layer of your tears. This oily substance is needed to keep your tears in place and protect your eyes.

Blepharitis that is caused by problems with the Meibomian glands is often known as Meibomian blepharitis.

Skin conditions, such as seborrhoeic dermatitis and rosacea (a skin condition that mainly affects the face), are known to affect how these glands work.

Seborrhoeic dermatitis

In the case of seborrhoeic dermatitis, the glands produce too much oil. As with anterior blepharitis, the excess oil is thought to provide a breeding ground for bacteria.

Rosacea

In the case of rosacea, not enough oil is produced. However, this is still a problem because your eyes are not being properly protected by your tears, so they also become vulnerable to infection.

About half of people with rosacea will experience associated eye symptoms, such as redness and irritation. Rosacea that affects the eyes is known as ocular rosacea, although this condition is unlikely to develop in people already taking oral antibiotics for rosacea.

Left untreated, ocular rosacea can lead to:

  • iritis (uveitis), inflammation of the iris (the coloured part of your eye)
  • keratitis, inflammation of the cornea (the transparent outer layer of your eye)

See the Health A-Z topic about Rosacea for more information about this condition.

Other causes

Less commonly, blepharitis can develop as a result of:

  • an allergic reaction
  • an infestation of lice on the eyelashes

Allergy
Allergy is the term used to describe an adverse (bad) reaction that the body has to a particular substance.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi.

Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some are good for you.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Meibomian glands
The Meibomian glands are located on the inside front edge of your eyelids. They produce a fatty liquid that makes up the outer layer of the tear film and protects your eyes.  

Page last reviewed: 13/07/2011

Most cases of blepharitis can be diagnosed by your GP, who will:

  • ask you about your symptoms
  • examine your eyes
  • check for any associated medical conditions, such as seborrhoeic dermatitis or rosacea (skin conditions)

Referral

Your GP may refer you to an ophthalmologist (a medical doctor who specialises in diagnosing and treating eye conditions) if:

  • your symptoms are particularly severe
  • your symptoms do not improve after treatment
  • your eyes are painful
  • your vision is blurred
  • you have experienced any loss of vision

The ophthalmologist will carry out further tests to make sure that your symptoms are not being caused by another condition, such as a more serious type of eye infection.

Page last reviewed: 13/07/2011

Blepharitis is a chronic (long-term) condition. Most people experience repeated episodes followed by periods with no symptoms.

Blepharitis cannot be cured, but symptoms can be effectively controlled with good eye hygiene. You will need to continue this eye hygiene programme indefinitely.

Eye hygiene

Developing a regular routine of eye hygiene is essential for the effective treatment of blepharitis. It is important to clean your eyelids every day, whether or not you have any symptoms. Make it part of your daily routine, like showering or brushing your teeth.

Effective eye hygiene will help reduce the severity and frequency of your symptoms. Follow the steps below to keep your eyes clean:

  • Apply a warm compress (a cloth or cotton wool warmed with hot water) to your closed eyelids for five to ten minutes.
  • Gently rub the compress over your closed eyelids for two to three minutes, then repeat. This will help loosen any crusting.
  • Use a cloth or cotton bud with warm water and a small amount of cleaning solution (see below), and gently rub the edge of your eyelids to clean them.
  • Always use a mirror when cleaning your eyelids to prevent any possible damage to your eyes.
  • Carry out these steps twice a day at first, then once a day when your symptoms have improved.
  • Do not wear eye make-up, particularly eyeliner and mascara, as this can make your symptoms worse. If you have to wear eyeliner, make sure that it washes off easily.

Cleaning solution

To clean your eyelids, use one of the following with warm water:

  • a small amount of baby shampoo (1 part baby shampoo to 10 parts warm water)
  • sodium bicarbonate (1 teaspoon dissolved in a cup of water)
  • a lid-cleaning solution (there are a number of commercial products available)

Your GP or pharmacist can tell you which cleaning solutions are suitable for you. However, you may need to try more than one product to find one that suits you.  

Topical antibiotics

If you have blepharitis that does not respond to regular cleaning, you may be prescribed a course of antibiotic ointments or creams (topical antibiotics). You will need to use these for four to six weeks.

You may be prescribed:

  • chloramphenicol eye ointment
  • fusidic acid eye drops

The ointment or drops should be rubbed gently onto the edge of your eyelids, using either clean fingers or a cotton bud. You may need to do this:

  • after you have finished cleaning your eyes
  • before you go to sleep at night
  • after cleaning your eyes and before bed

Once your condition begins to respond to the treatment, you will only need to apply the antibiotic once a day.

Cautions

Avoid wearing contact lenses when using topical antibiotics. If wearing contact lenses is essential, you may be given additional eye drops. If you are using more than one type of eye drop, leave at least five minutes before applying the second type of drops to your eyes.

You may experience some mild stinging or burning when applying antibiotic ointment or drops to your eyes, but this should pass quickly. Do not drive if the ointment makes your vision blurred.

Oral antibiotics

In some circumstances, you may be prescribed oral antibiotics (to take by mouth) at the start of your treatment. For example, oral antibiotics may be prescribed when it is clear that a skin condition, such as rosacea, is aggravating your blepharitis. Oral antibiotics may also be recommended if your blepharitis does not respond to other forms of treatment.

Most people respond well after two to four weeks of treatment, although you will probably be required to take them for at least six weeks. It is important for you to finish the course of antibiotics, even if your symptoms get better.

Cautions

Some of the oral antibiotics that are used to treat blepharitis have been known to make people more sensitive to the effects of the sun. Therefore, avoid prolonged exposure to sunlight and using sun lamps or sun beds while you are taking them.

Side effects of oral antibiotics are rare because the dose is relatively low. However, they may include: 

  • nausea (feeling sick)
  • vomiting
  • stomach ache
  • diarrhoea
  • yeast infections, such as thrush, in women

If you develop a severe headache or notice any changes in your vision, see your GP immediately. These symptoms may indicate a rare but serious side effect that is caused by some types of oral antibiotics.

Treating other conditions

You may need to use an anti-dandruff shampoo on your scalp and eyebrows if you have:

  • seborrhoeic dermatitis (a skin condition that causes your skin to become inflamed or flaky)
  • dandruff (dry, flaky skin on your scalp)

See the Health A-Z topic about Dandruff - treatment for more information about treating this condition. 

If you have dry eye syndrome, which frequently occurs alongside blepharitis, you may need separate treatment for this, such as eye drops.

See the Health A-Z topic about Dry eye syndrome - treatment for more information about treating this condition.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi.

Page last reviewed: 13/07/2011

Serious complications of blepharitis are rare. The most common problem associated with blepharitis is being unable to wear contact lenses. It may be necessary to use an alternative, such as glasses, until your symptoms are under control.

Dry eye syndrome

Dry eye syndrome is a common complication of blepharitis. Dry eye syndrome (also known as keratoconjunctivitis sicca) occurs when your eyes do not make enough tears, or the tears evaporate too quickly. This can lead to the eyes drying out and becoming inflamed (red and swollen).

Dry eye syndrome can occur because skin conditions associated with blepharitis can also affect the quality of your tears. These skin conditions include seborrhoeic dermatitis (a condition that causes your skin to become inflamed or flaky) and rosacea (a condition that mainly affects the face) .

The symptoms of dry eye syndrome include:

  • feelings of dryness, grittiness or soreness, which get worse throughout the day
  • watering eyes, particularly when you are exposed to wind

The symptoms of dry eye syndrome can usually be successfully controlled using eye drops that contain 'tear substitutes'. This is a liquid that is designed to mimic the properties of tears. The eye drops are available over-the-counter from pharmacists without a prescription.

See the Health A-Z topic about Dry eye syndrome for more information about this condition.

Conjunctivitis

Conjunctivitis is an inflammation of the conjunctiva. The conjunctiva is the transparent membrane (thin layer of cells) that covers the white part of the eyeball and the inner surfaces of the eyelids.
 
Conjunctivitis occurs when bacteria in the eyelid infect the eyes. The condition is not usually serious and should not affect your vision.

Most cases of conjunctivitis will pass in one to two weeks without the need for treatment. Antibiotic eye-drops may be prescribed if your symptoms persist, or you have repeated infections. However, there is little evidence that antibiotic eye drops resolve the condition any quicker than waiting for it to clear up on its own.

See the Health A-Z topic about Infective conjunctivitis for more information about this condition.

Meibomian cyst

A Meibomian cyst is swelling on the inside of your eyelids. A cyst can develop if one of your Meibomian glands (the glands that produce a fatty liquid that protects your eyes) becomes inflamed as a result of blepharitis.

Cysts are normally painless, unless they get infected. In this case, antibiotics may be needed. Applying a hot compress to the cyst should help bring the cyst down, although cysts disappear by themselves. If a cyst does not disappear, it can be removed with a simple surgical procedure carried out under local anaesthetic (painkilling medication).

Styes

A stye is a painful swelling that produces pus and develops on the outside of your eyelid. Styes are caused by a bacterial infection of an eyelash follicle (the base of your eyelash).

A mild stye can be treated by applying a warm compress (a cloth warmed with hot water) to the area. More serious cases can be treated with antibiotic creams and tablets.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi.

Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some are good for you.

Conjunctiva
The conjunctiva is the transparent membrane (thin layer of cells) that covers the white part of the eyeball and the inner surfaces of the eyelids.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Meibomian glands
The Meibomian glands are located on the inside front edge of your eyelids. They produce a fatty liquid that makes up the outer layer of the tear film and protects your eyes.  

Page last reviewed: 13/07/2011

Following a daily eye hygiene routine is the best way to prevent episodes of blepharitis (see Blepharitis - treatment).

Also, seek treatment for any related skin conditions as they can often be controlled with the right treatment.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z