Overview

Blepharitis is the inflammation of the eyelid, which leads the eyelids to turn into red or dark colour and become swollen and scaly. This can affect both the eyelid and can develop into an infection. This can cause painful tenderness and discomfort. Blepharitis commonly occurs when the oil glands present at the base of the eyelashes get clogged. This leads to irritation and redness. Blepharitis does not cause permanent damage to the eyesight and is not contagious. Eyelid care and regular hygiene practice reduce the symptoms of blepharitis.¹

Blepharitis can be caused by several other disease conditions. Chronic blepharitis is difficult to treat but does not lead to blindness.

Blepharitis

Blepharitis is a condition affecting the eyelid margin causing inflammation, irritation and crusts on the lashes. It commonly occurs when the tiny oil gland near the eyelashes gets clogged. The eyelids become itchy, and crusted with scales and sometimes the eyelids can be stuck together upon waking.¹

Types of blepharitis

It is categorised depending on which area of the eyelid is affected. There are two types and they are: 

1. Anterior blepharitis  

This occurs outside the front edge of the eyelid where the eyelashes attach. This is commonly caused by bacteria (staphylococcal blepharitis) or dandruff from the scalp and eyebrows. The causes include: 

• Acne rosacea: It is a common skin condition that causes long-term redness on the face, enlarges the blood vessels and pus-filled bumps. These symptoms may take weeks or in severe cases months to go away. This also affects the eyelids
• Dandruff (seborrheic dermatitis): It causes skin flakes on the scalp, hair, beard, eyebrows and shoulder. It causes itchiness in the area affected²
• Dry eyes: It is a condition that occurs when the tears are inadequate to lubricate the eyes. This instability can cause inflammation and damage to the eyes³
• Allergies: Allergic reactions to makeup, eye drops and contact lenses can increase the irritation⁴
• Demodex (a type of mite): These microscopic mites live in human hair follicles such as eyelashes, forehead, cheeks, sides of the nose and outside the ear canal. They are generally harmless, but too many of them can cause blepharitis because an immune response will be initiated⁵

2. Posterior blepharitis  

This occurs in the inner edge of the eyelid that touches the eyeball. This occurs when glands in the eyelids irregularly produce oil or do not produce good quality oil (meibomian blepharitis).^6,7 The causes include: 

• Meibomian gland dysfunction: This condition occurs when the oil-secreting glands in the eyelid do not secrete the quality and adequate quantity of the oil to prevent dry eyes.^6,7
• Acne rosacea
• Dandruff²

Symptoms

There are many signs and symptoms present for the condition blepharitis and some of them are: 

• Swollen eyelids
• Watery eyes
• Irritation causing itching or burning sensation
• Redness
• Formation of crust on the eyelashes near the corners of the eyelid making them stick together
• Dry eyes³
• Frequent blinking of the eyes
• Photophobia: It is the condition causing light sensitivity, where bright light can cause pain and discomfort to the eyes⁸
• Collection of skin flakes on the eyelids and around the eyelid
• Loss of eyelashes
• Blurred vision

Complications

• Style: It is a painful red bump that is present on the edge of the eyelid. It looks similar to acne. This occurs when the oil gland in the eyelid becomes blocked and develops a bacterial infection. Style usually lasts up to one or two weeks and goes away on its own. But if it doesn't go away then a visit to the doctor is necessary. Antibiotics may then be prescribed to reduce the infection⁹
• Loss of eyelash: Blepharitis can make eyelashes fall out, lighten their colour and new eyelashes grow in odd directions
• Dry eyes: It is a condition when the tears are inadequate to lubricate the eyes³
• Chalazion: It is a red swollen bump that forms on the eyelid when the oil gland becomes blocked. At first, chalazion is painful but after some time the pain decreases¹⁰
• Keratitis: It is the inflammation or irritation of the cornea. It can be infectious keratitis (caused by bacteria, viruses, parasites and fungi) or noninfectious keratitis (caused by injury from contact lens or from any foreign body getting in the eye). It can cause eye pain, watery eyes, redness, irritation and blurred vision¹¹
• Conjunctivitis: It is a condition caused by infection or allergies. This can cause redness in the eyes, itchiness and burning sensation¹²

Diagnosis

An ophthalmologist is the doctor who checks the eyes and recommends the way of treatment for an eye condition. The doctor may ask about any past conditions and a detailed history of their eye health. They may ask about any accident that has happened that may affect the eye.

• Physical examination: At first, the doctor uses a magnifying instrument to examine the eyes and the eyelids
• Swab skin test: The doctor collects the sample of oil or crust that forms on the eyelid to examine for any bacteria, fungus or any allergy present

Management and treatment

The most important treatment given for blepharitis is personal hygiene, such as washing the eyes using warm water and using warm water compresses. If the condition worsens the doctor may recommend medications which include: 

• Antibiotics are recommended by the doctor to decrease the symptoms and to treat any bacterial infection present. They may provide eyedrops and an ointment. In some cases, the doctor may recommend oral antibiotics
• Doctors may prescribe both antibiotics and anti-inflammatory medications to control the inflammation
• Blepharitis may occur due to an underlying condition, such as skin conditions or any eye ailments that can cause blepharitis. In these cases, the doctor may recommend medication for the underlying cause. 

Personal hygiene to prevent blepharitis

In most cases of blepharitis, the most important treatment needed is self-care and personal hygiene:^7,13

• Always keep your hands and face clean
• Only touch your face or eyes with clean hands
• Try not to touch your eyes if there is an itching sensation
• Clean the eyes daily using warm water
• Remove all eye makeup before going to bed
• Using over-the-counter artificial tears (eyedrops) to reduce dry eye if necessary, since eyedrops help  lubricate the eyes³
• Wipe away excess tears or eye drops with a clean cloth or tissue
• If there is any eye infection it is recommended not to use contact lenses until the condition is solved
• Replace eye makeup like eyeliner, mascara and eye shadow if the date is expired 
• In case of crust formation or scales use a clean washcloth moistened with warm water to clean the eyelids. This helps remove the scales from the eyelids
  • Always rinse the eyes with warm water and pat dry with a clean cloth
  • Use separate cloths for each eye while cleaning
• Control dandruff and mites: If you have dandruff, your doctor or pharmacist may recommend anti-dandruff shampoo. This may reduce the symptoms of blepharitis²
• Use glasses while travelling to avoid infection from dust or any foreign particles 

FAQs

Can blepharitis be caused by poor hygiene?

Blepharitis can occur due to multiple reasons. However, chronic blepharitis can occur due to poor personal hygiene.

How can you treat blepharitis with hygiene?

The symptoms and reoccurrence of blepharitis can be reduced by proper personal hygiene. Cleaning the eyes daily using clean hands and pat dry them with clean cloths, only touching the eyes with clean hands and removing makeup before bed. Artificial tear drops can also be used to reduce the dryness of the eyes.

What aggravates blepharitis?

Blepharitis symptoms get worse during cold weather, prolonged use of computers, reduced sleep and using contact lenses while having eye infections.

What should you avoid if you have blepharitis?

Avoid touching the eye with your hands while having eye irritation, and avoid using eye makeup and usage of contact lenses. These will help in reducing the symptoms of blepharitis.

When should I consult a doctor for blepharitis?

Usually, blepharitis symptoms go away on their own within one or two weeks. If the symptoms are present beyond two weeks and if symptoms get worse, it is recommended to consult a doctor immediately.

Conclusion

Blepharitis is the inflammation of the eyelid, which leads the eyelids to turn into red or dark colour and become swollen and scaly. Blepharitis commonly occurs when the oil glands present at the base of the eyelashes get clogged. This leads to irritation and redness. It commonly occurs when the tiny oil gland near the eyelashes gets clogged. The eyelids become itchy, crusted with scales and sometimes stuck together upon waking. The treatment given for blepharitis is personal hygiene, such as washing the eyes using warm water and using warm water compresses. If the condition worsens, the doctor may recommend antibiotics. Blepharitis does not cause any permanent damage to the eye sight and is not contagious. Eyelid care and regular hygiene practices reduce the symptoms of blepharitis.