If your child has woken up with red, inflamed, and crusty eyes, they are likely to be suffering from blepharitis – a common inflammatory condition of the eyelids. This article will take you through the common symptoms to help you identify blepharitis in your child, understand why they might have developed it, and how you can help relieve the discomfort caused by this condition.

What is blepharitis?

Blepharitis is a common condition of the eyelids that causes them to be inflamed, watery and crusty. It is often a chronic condition, with individuals experiencing flare-ups on and off for months or years. Still, it can also be acute, with symptoms improving within a week following treatment. Blepharitis does not discriminate and can affect people of all ethnicities and genders, as well as adults and children.¹

Although it is not usually serious and doesn’t typically cause damage to the vision or eyes, if left untreated, blepharitis does have the potential to lead to other, more complicated, eye conditions which could impair a child’s vision. There is currently no cure for blepharitis but long-term, consistent management relieves symptoms and can prevent future flare-ups.

The two distinct categories of blepharitis are defined by the parts of the eyelids affected:

• Posterior blepharitis – affects the inner eyelid (the moist part that makes contact with the eye). It is most commonly caused by the oil glands in the eyelids becoming dysfunctional, creating a favourable environment for bacteria to grow
• Anterior blepharitis – affects the front of the eyelid, along the lash line. It is most often caused by bacteria commonly found on the face and eyelids which can cause a reaction if they become excessive or the lid area reacts poorly to their presence

Some people experience posterior blepharitis and anterior blepharitis together. This is called mixed blepharitis.

Understanding blepharitis

Causes

The exact causes of blepharitis are not fully understood. However, it is thought that three main causes can work separately or together:

• Staphylococcus bacteria – Blepharitis can be caused by a sensitivity of the skin around the eyelids to a type of bacteria found on the skin called Staphylococcus. Higher levels of Staphylococcus colonisation are seen in the eyelids of blepharitis patients and it is thought to trigger hypersensitivity reactions²
• Clogged glands – Small glands in the eyelids called meibomian glands produce oils to keep the eyes moist. The oil they produce forms part of the tear film that prevents moisture from evaporating from the eye. These glands can become clogged or dysfunctional, affecting the eye’s oil production, which can be a cause of blepharitis 
• Demodex mites – An overpopulation of microscopic Demodex mites living inside the eyelash follicles can lead to blepharitis. This is the most common cause of blepharitis with one study showing 80% of blepharitis cases presenting with Demodex mites³
• Dermatologic conditions – Those who already suffer from dermatologic conditions including eczema, acne or seborrheic dermatitis are more likely to also experience blepharitis⁴

Symptoms

Symptoms of blepharitis can vary among individuals. However, the condition is usually identified by a combination of the following:

• Swelling and redness of eyelids
• Itching/burning sensation in the eyes
• Crusting or flaking around eyelashes (may result in eyelids becoming stuck together upon waking in the morning)
• More frequent blinking
• Light sensitivity
• Worsening of symptoms in the morning. If symptoms are worse in the evening, this is a common characteristic of aqueous deficient dry eye disease

Diagnosis 

There is no single test to diagnose a patient with blepharitis. If your child experiences symptoms of blepharitis, try the daily eyelid hygiene technique outlined below. If symptoms persist after a week, bring your child to your GP or an ophthalmologist. They will perform a closer examination of the eye using a high-powered microscope called a slit-lamp microscope to look for blockage of glands, inflammation in the eye and the presence of bacteria. 

They may also ask about your child’s medical history to understand whether other factors, such as any existing dermatologic conditions, may be causing chronic blepharitis. Swabs might also be taken to test for bacterial or fungal cultures associated with the condition and to rule out other infections.

Treatment options

Daily eyelid hygiene

The primary treatment for blepharitis is practising good eye hygiene.¹ It will not only alleviate discomfort but also prevent flare-ups from recurring. This three-step procedure using a warm compress should be repeated between two and four times daily while your child is experiencing symptoms. If suffering from chronic blepharitis, patients should practice eyelid hygiene at least once daily, maintaining a strong eyelid hygiene regimen on a long-term basis.

1. Wet a clean flannel in warm water and rest it on your child’s eyelids for 10 minutes, with their eyes closed. This will soften the crusty build-up and also dilate the meibomian glands
2. Follow this with gentle scrubbing of the eyelids using a cotton applicator soaked in either lid-scrub products (available at your local pharmacy) or baby shampoo. If suffering from posterior blepharitis, small circular massaging motions will also encourage the glands to produce oils
3. Rinse clean with fresh water

Applying a cool compress can provide additional relief by reducing inflammation. This is done by resting a cold compress (ice wrapped in a tea towel) on closed eyes for 10 minutes. 

At-home remedies

Inexpensive and easily accessible at-home remedies, such as tea tree oil, honey or omega-3 supplements, may be all that is needed to treat many cases of blepharitis.

• Tea tree oil – Recent research has shown promising results for the use of tea tree oil as a topical treatment for blepharitis. Tea tree oil contains a component called 4-terpineol which can kill Demodex mites without harming the user’s skin.⁵ Tea tree oil is therefore a commonly used home remedy for blepharitis
• Honey – Honey is well-known for its anti-inflammatory and anti-microbial properties. An important component of honey that is responsible for these properties is methylglyoxal, an organic compound that is found naturally in higher concentrations in manuka honey. Manuka honey eye drops are available over-the-counter and will ease symptoms⁶
• Omega-3 supplements – Omega-3 supplements have been shown to reduce inflammation associated with posterior blepharitis and improve gland function within those suffering from anterior blepharitis. These supplements are available at most supermarkets, pharmacies and health food shops. Dietary changes to include greater amounts of omega-3 can have similar effects. Foods high in omega-3 include fish (mackerel, salmon and cod liver oil) or seeds (flax/chia)⁷

Medications

A doctor may prescribe antibiotic eye drops such as chloramphenicol to treat severe blepharitis. However, once symptoms have been relieved, simple hygiene measures should prevent the disease from recurring. In severe cases, steroid eye drops may also be required.

Importance of addressing blepharitis in children

As with all conditions, it is of great importance that blepharitis in children is effectively treated. This is due to a handful of reasons:

• Comfort – No parent wants to see their child experiencing discomfort. Blepharitis is particularly discomforting with sticky eyes which are more sensitive to light; particularly during the mornings. Soothing their symptoms can usually be done very simply from home
• Complication prevention – Untreated blepharitis can potentially lead to more serious infections including conjunctivitis, a stye, and even corneal damage (affecting vision) in the most serious cases
• Preventing the spread of infection – As blepharitis is commonly caused by bacteria/mites it can sometimes be contagious. It’s therefore important the condition is detected to minimise the spread to family or class members
• Education – Conditions such as blepharitis can lead to a child missing several days of school a year. If your child is suffering from chronic blepharitis, this could also easily escalate to weeks of absence from school, which will have detrimental effects on their education. All of this underscores the importance of good eye hygiene practice, even when symptoms aren’t present, to minimise time absent from school

Summary

Blepharitis is a common eye condition characterised by inflammation and redness of the eyelids and crusting or flaking around the eyelashes. It is experienced by both adults and children and by people of all genders and ethnicities. Blepharitis is not a contagious condition and doesn’t typically cause damage to the vision or eyes. However, if left untreated, it can lead to other, more complicated, eye conditions which could impair a child’s vision.

The primary treatment for blepharitis is practising good eye hygiene using a warm, wet compress and rinsing the eyelids with lid-scrub products or baby shampoo. Other simple remedies that can be used at home include tea tree oil, honey and omega-3 supplements. For more severe cases of blepharitis, a doctor may prescribe antibiotic eye drops or steroid eye drops to treat the infection.