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Blepharitis
Blepharitis Content Supplied by NHS Choices
Introduction

Blepharitis is inflammation of the rims of the eyelids, which causes them to become red and swollen. 

Blepharitis is common, accounting 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.

The symptoms of blepharitis can include:

  • 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 of 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.

Read more about the causes of blepharitis.

When to see your GP

See your GP if you are unable to control the symptoms of blepharitis with cleaning alone.

You may be referred to an opthalmologist (eye specialist) if you have severe symptoms.

Read more about diagnosing blepharitis.

Treating blepharitis

Blepharitis is usually a long-term (chronic) condition, which means 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. This will need to be continued indefinitely. More severe cases of blepharitis may require antibiotics.

Read more about how blepharitis is treated.

Complications

Blepharitis is not usually serious. The most common complication is being unable to wear contact lenses while experiencing symptoms.

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

Serious complications, such as sight loss, are rare, particularly if recommended advice is followed.

Read about the complications of blepharitis.

Symptoms of blepharitis

Most people with blepharitis experience repeated episodes with long periods of time where they do not have any symptoms in between. Both eyes are affected by blepharitis.

Symptoms can vary depending on the cause. They tend to be worse in the morning and can include:

  • itchy, sore, red eyelids
  • eyelids that stick together and are difficult to open when you wake up
  • eyelashes that become crusty or 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.

Read more information about the causes of blepharitis.

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

If you have blepharitis that is caused by rosacea (a skin condition that mainly affects the face), you may also have flushing (redness) and 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).

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
Causes of blepharitis

Blepharitis is inflammation (redness and swelling) along the edge of your eyelids. It is most often caused by an infection or a skin condition.

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 the staphylococcus bacteria. This is known as staphylococcal blepharitis.

Anterior blepharitis is often the result of seborrhoeic dermatitis (a skin condition that causes your skin to become inflamed or flaky). As seborrhoeic dermatitis causes oily skin, it is thought that the excess oil irritates the eyelids, providing a breeding ground for bacteria. This is often referred to as seborrhoeic blepharitis and can also cause posterior blepharitis.

Posterior blepharitis

Posterior blepharitis is caused when something affects the Meibomian glands found on the rim of your eyelids. These are responsible for producing an oily substance that makes up the top layer of your tears and keeps your tears in place. This is often known as Meibomian blepharitis.

Skin conditions, such as seborrhoeic dermatitis and rosacea, are known to affect how these glands work.

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)

Other causes

Less commonly, blepharitis can develop as a result of:

Diagnosing blepharitis

Your GP can diagnose most cases of blepharitis by asking about your symptoms and examining your eyes.

Your GP may also check for any associated medical conditions, such as seborrhoeic dermatitis or rosacea (skin conditions).

Read more information about the causes of blepharitis.

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.

Treating blepharitis

Blepharitis cannot be cured, but symptoms can be controlled with good eye hygiene.

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

Eye hygiene

It is important to clean your eyelids every day, whether or not you have any symptoms.

Good eye hygiene helps ease your symptoms and prevents them from reoccurring. 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.
  • 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 which has been boiled and then cooled)
  • 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, up to three times a day, using either clean fingers or a cotton bud. 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. Let your GP know 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 blurs your vision.

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 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 oral antibiotics 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 vomiting, diarrhoea and yeast infections in women  

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)

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

Complications of blepharitis

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 glasses until your symptoms are under control.

Dry eye syndrome

Dry eye syndrome is a common complication of blepharitis. It 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).  It causes your eyes to feel dry, gritty and sore or watery.

The skin conditions associated with blepharitis can also affect the quality of your tears. This includes seborrhoeic dermatitis (a condition that causes your skin to become inflamed or flaky) and rosacea (a condition that mainly affects the face).

Eye drops containing 'tear substitutes' are usually enough to control dry eye syndrome. These eye drops are available over-the-counter from pharmacists, without a prescription.

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 are mild and will pass in one to two weeks without the need for treatment. More severe cases of conjunctivitis are more likely in contact lens wearers.

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.

Meibomian cyst

A Meibomian cyst is swelling on the inside of your eyelids. A cyst can develop if one of your Meibomian glands (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).

Read more information about eyelid problems.

Styes

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.

Preventing blepharitis

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.

 
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