The term “Blepharitis” (pronounced as bleh-fur-RY-tis) might sound intimidating, but it refers to inflammation of the eyelids. Environmental factors play an important role in the presentation and duration of blepharitis.¹ In general, blepharitis is characterised as itchy, sore, irritated eyes along with red, swollen, flaky eyelids, however, it is not contagious. This condition can affect people of any age and most people develop blepharitis at least once in their lifetime. 

Overview of blepharitis

There is no specific cause for blepharitis because many factors coexist and influence its appearance, which makes it one of the most common reasons for GP consultation.² There are two types of blepharitis:

1. Anterior blepharitis - Affects the outside of the eyelids where it attaches to the eyelashes. It is commonly caused by excessive amounts of bacteria harbouring Demodex mites (micro mites that live on human hair follicles, in this case, eyelashes)³ 
2. Posterior blepharitis - Affects the internal border of the eyelid where it touches the eyeball. It is mainly caused by meibomian gland dysfunction. Meibomian glands are specialised in secreting oil to lubricate the eyelids, but if they are blocked, or if the oil secreted becomes heavily viscous, blepharitis can develop as a consequence. Conditions such as scalp dandruff or rosacea can also be causes of posterior blepharitis. Additionally, both types of blepharitis can overlap.

Common signs and symptoms

• Itchy eyes 
• Irritation or burning sensation in the eyes
• Watery or dry sensation in the eye
• Red and swollen eyelids
• Flaky skin around the eyes
• Crusts in the base of eyelashes
• Blurry vision
• Light sensitivity
• Constant blinking
• Sticky eyelids, especially while waking up in the mornings
• Notches in the borders of the eyelids
• Loss of eyelashes
• Lumps in the eyelids 

Besides the signs and symptoms, the diagnosis of blepharitis requires a physical examination of the eyes, eyelids and eyelashes. Sometimes, it is necessary to use a microscope to check the eyelashes to look for Demodex mites.³ Improving the hygiene of the eyelids is part of the treatment, and it can be helpful to prevent events post-blepharitis. 

How to ease your eyes during blepharitis?

• Place a warm water water-soaked cotton patch on the affected eye for 5 minutes
• Gently massage the eyelids for 30 seconds.
• If necessary, use a mild baby shampoo to clean the flakes or crusts on the eyelids.
• Avoid using contact lenses while you have visible symptoms of blepharitis
• Do not wear eye m<ke up, especially mascara or eyeliner, as they may aggravate symptoms

Environmental factors contributing to blepharitis

Air pollution

The constant exposure to air pollution in big cities has an important impact on the development of blepharitis and the symptoms associated with it. This is because of air pollutants, such as nitrogen dioxide, carbon monoxide or ozone, which are capable of causing changes in the surface of eyelids or in the quality of the oil generated by meibomian glands.¹

Climate and weather conditions

Certain weather conditions can be risk factors as those influence the presence of dry eye.⁴ This may cause the repetitive appearance of blepharitis. For example, the presence of high or low humidity, high temperature, constant exposure to ultraviolet radiation, windy places or places with continuous air-conditioning.^4,5

Allergens 

Animals, pollen, dust mites or  other mites, such as Demodex, are some of the most common causes of allergies in the eyes. These factors can irritate the surface of the eyelids, causing four main symptoms: itchiness, redness, watering, and swelling overlapping with dry eyes.⁶ As these symptoms come and go, blepharitis, and other eye conditions associated with allergies, tend to go underdiagnosed and undertreated. Currently, there has been an increase in research about how changing diets might play an active role in the treatment of blepharitis.⁷

Work environments

Chronic eye irritation and dry eye, which are associated with blepharitis, have been constantly found in persons working in indoor environments such as offices or aircraft.⁸ In addition, in outdoor environments, the risk of dry eye increases because of exposure to sunlight, dust and other particles in the air, mainly in tropical climates.⁹ Therefore, it is recommended to use proper personal protection equipment.  

Summary

Blepharitis is the inflammation of the eyelids. Usually, blepharitis is accompanied by other eye conditions such as dry eye. Due to many factors that can overlap and cause blepharitis, it is important to maintain clean eyes with good hygienic measures. It is essential to see a doctor to avoid this condition from getting worsened, and generating complications such as lumps in your eyes, loss of lashes, blurry vision, or severe pain and irritation. 

Environmental factors play an important role in the appearance and recurrence of blepharitis. Air pollutants can contribute to change the structure of the eyelid, or the quality of  oil produced by meibomian glands. Certain weather conditions can cause dry eyes, and influence the recurrence of blepharitis. Allergens work environments can also be causes of blepharitis, , and so the use of personal protection equipment is crucial to prevent recurrence.

FAQs

What is the main cause of blepharitis?

Anterior blepharitis is caused by bacteria, dandruff, mites or allergies. Posterior blepharitis is usually caused by a dysfunction of meibomian glands.

What is the best thing to do for blepharitis?

To maintain clean eyelids and good eye hygiene.

What eye condition is similar to blepharitis?

Meibomian gland dysfunction, which is one the causes of posterior blepharitis.

How often should you wash your eyes with blepharitis?

Washing your eyelids once or twice a day is recommended to keep eyelids clean and free of crusts.

Should I stay at home if I have blepharitis?

No, because it is not a contagious condition.

Do I need to see a doctor for blepharitis? 

Yes, because the symptoms such as crusts in the base of eyelashes, blurry vision, or light sensitivity require to be promptly examined and treated by your doctor.

What makes blepharitis worse?

The use of makeup, contact lenses, extreme weather conditions or places with air-conditioning.

Can stress cause blepharitis?

Stress can be one of the factors related to triggering belepharitis.

What are the red flags of blepharitis?

Severe irritation or severe pain in the eyes, excessive watery eyes, blurry vision or difficulty to focus on objects.

What happens if blepharitis is left untreated?

Even though blepharitis alone does not threaten your eye sight, if it is not treated, it might change the structure of eyelids, eyelashes and eyes in general. Consequently, it might become precedent for conditions such as marginal keratitis or corneal neovascularization.