Eyelid Trouble: Managing Blepharitis

The condition can make your eyelids red, swollen, irritated, and itchy. It can also cause crusty dandruff-like flakes to form on your eyelashes. Though rarely dangerous, blepharitis may cause discomfort and pain.

The main cause of blepharitis is extra growth of the normal bacteria found on your skin. Other conditions, including allergies, rosacea, certain mites, dandruff, or oily skin can increase the risk of this bacterial overgrowth.

Blepharitis can lead to other eye problems. Common ones include a stye, which is a red, painful bump on the eyelid caused by a blocked oil gland. A chalazion is like a stye, but doesn’t hurt, though it can make your eyelid swell and turn red. Very rarely, blepharitis can cause damage to the cornea—the clear outer layer at the front of your eye.

Blepharitis often contributes to another common eye problem called dry eye. In this condition, oil and flakes alter the thin layer of tears that sits across the surface of your eye. This can make your eyes feel dry.

But some people’s eyes instead feel watery or teary because their tears aren’t working correctly. That’s because of inflammation on the eye’s surface.

“Patients with dry eye tell me that their eyes water all the time, especially in windy environments,” explains Dr. Jason Nichols, an eye doctor who studies dry eye diseases at the University of Alabama at Birmingham.

Once someone develops blepharitis, it never totally goes away. But flare-ups can be managed and prevented. Most people can keep the condition in check with good eyelid hygiene. The main treatment for blepharitis is regularly cleaning your eyelids and keeping them free of crusts. Talk to your eye doctor about what’s causing your blepharitis and the best ways to manage it.

“But people have to be consistent and clean their eyes daily,” says Nichols.

Some people with blepharitis may be prescribed antibiotics. Others need medications to reduce inflammation or keep their eyes moist.

If you have recurring irritation of your eyes or your eyelids, Nichols says, “see an eye care provider, and make sure you get an accurate diagnosis.”

Nichols’ research team is working on developing imaging and other methods to look closely at the surface of our tears and oil glands in the eyes. This may help them better understand what happens when the eyelids get irritated.

“We often take our eyes for granted, but when things go wrong, it really does have an impact on quality of life,” Nichols says.

What are the symptoms of blepharitis?

Common symptoms of blepharitis are:

• Feeling like there’s something in your eye
• Burning or stinging eyes
• Watery eyes
• Itchy eyes
• Sensitivity to light
• Red and swollen eyes or eyelids
• Tears that are foamy or have small bubbles in them
• Dry eyes
• Crusty eyelids or eyelashes when you wake up

Blepharitis can also cause more serious problems like:

• Blurry vision
• Eyelashes that fall out
• Eyelashes that grow in the wrong direction
• Swelling of other parts of the eye, like the cornea

Am I at risk for blepharitis?

You’re at higher risk for blepharitis if you have:

• Dandruff — flaky patches of skin on your scalp or face
• Rosacea — a skin condition that causes redness and bumps, usually on your face
• Oily skin
• Allergies that affect your eyelashes

What causes blepharitis?

Most of the time, blepharitis happens because you have too much bacteria on your eyelids at the base of your eyelashes. Having bacteria on your skin is normal, but too much bacteria can cause problems. You can also get blepharitis if the oil glands in your eyelids get clogged or irritated.

What are the types of blepharitis?

There are 2 types of blepharitis. You may have 1 type of blepharitis, or you may have both types at the same time.

Anterior blepharitis. Anterior blepharitis affects the outside of your eye, where your eyelashes attach to your eyelid. It usually happens because of bacteria on your skin or dandruff from your scalp or eyebrows. Allergies or mites (tiny parasites) may also cause anterior blepharitis, but this is rare.

Posterior blepharitis. Posterior blepharitis affects the outside of the inner edge of the eyelid — the part that touches your eye. This type of blepharitis happens when the oil glands in your eyelids get clogged. Common skin conditions like rosacea and scalp dandruff can cause posterior blepharitis.

Eyelid Care

Steps for cleaning your eyelids when you have blepharitis:

• Wash your hands with soap and water.
• Mix warm water with a gentle cleanser on a soft washcloth.
• Press the cloth against your closed eye for a few minutes to loosen the crusts. This can also help keep your oil glands from clogging.
• Gently rub the cloth back and forth, focusing on the area where your eyelashes meet your eyelids.
• Rinse your eye with clean water.
• Commercially available eyelid cleaning wipes and non-allergenic makeup removal wipes are also available.

There are other treatment options that may help you manage blepharitis. Ask your eye doctor if any of these options are right for you:

• Eye drops. Your doctor may prescribe steroid eye drops to control redness, swelling, and irritation. Your doctor may also recommend a type of eye drops called artificial tears. You can get these eye drops without a prescription.
• Medicines that fight infection. If your blepharitis is caused by bacteria, your doctor may prescribe antibiotic eye drops, ointments, or pills.
• Treating other health problems. If another health problem like rosacea or dandruff is causing your blepharitis, treating that condition will help.

Blepharitis usually doesn’t go away completely. You’ll need to follow a routine for cleaning your eyelids for the rest of your life to keep it under control.