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Eyelids and eyelashes are essential to the health of the eyes. They keep the eyes moist, lubricate them with oils, wipe them clean, and protect them from nasty germs and harmful debris. So when blepharitis strikes, causing the eyelid margins to swell and redden, it can cause a host of problems. While there is no cure, since most patients have recurring episodes over time, there are plenty of ways to minimize blepharitis symptoms and keep the problem at bay
What is blepharitis?
Blepharitis is a common eye problem characterized by swelling of the eyelid margin. In addition to redness and swelling of the eyelid margin, patients often experience itching, burning, a feeling of “grit” in the eye, crusting around the eyes, and either watery or dry eyes.
While blepharitis can be a temporary condition, called acute blepharitis, most people with blepharitis experience periodic flare-ups followed by weeks or months of remission, called chronic blepharitis.
There are two types of blepharitis depending on where the eyelid inflammation occurs.
Anterior blepharitis, the less common type, is inflammation of the eyelid margin at the base of the eyelashes. It has several causes including bacterial infection (infectious blepharitis), allergic reactions (atopic blepharitis), a mite infestation of the eyelash follicles (Demodex folliculorum), or skin conditions such as seborrheic dermatitis.
Posterior blepharitis, the more common type, affects the tissues just under the inner eyelid margin and is usually caused by problems with the eye’s oil glands, or meibomian glands. Right at the eyelid margin, these glands secrete oils that lubricate the surface of the eye. When the meibomian glands are blocked up, the inner eyelid margin swells up. There are several causes for meibomian gland dysfunction, but the most common is rosacea, a skin condition related to acne. Besides meibomian gland dysfunction, other causes of posterior blepharitis include conjunctivitis, mite infestation (Demodex brevis), eczema, and allergic reactions.
In most patients, blepharitis is not a health threat or emergency. Chronic blepharitis, however, can lead to complications such a dry eye, blurred vision, stye, conjunctivitis, or the inability to wear contact lenses. Potentially severe complications include swelling of the cornea, corneal ulcers, or an eye infection.
No-one knows for certain how many people are affected by blepharitis. Since most people treat the condition at home, it’s hard to count the cases. According to some studies, there are somewhere between 25 million to 180 million people in the United States who experience blepharitis at some point in their lives.
How is blepharitis diagnosed?
Blepharitis is diagnosed from the symptoms and a physical examination of the eyelid. An optometrist, family physician, nurse practitioner, or ophthalmologist can all diagnose and treat blepharitis, but severe or chronic cases will be referred to an ophthalmologist, or eye doctor.
The common symptoms of blepharitis are:
- Stinging, burning, or itchy eyelids
- Swollen and red eyelid margins
- Crusty build-up along edges of the eyes
- Excessive tears or dry eye
- A gritty feeling on the eye’s surface
- Blurred vision
- Flaky skin on the eyelid
- Sensitivity to light
These symptoms tend to be at their worst in the morning, particularly eyelid crusting. Both eyes are usually affected.
A healthcare professional will examine the eyelid through a slit lamp and look for swelling, redness, and possibly spider veins around the eyelid’s margins, eyelash problems, sores, or oil gland problems. The surface of the eye will be examined closely for possible injuries or sores. A fluorescein dye will be put on the eye to measure how quickly the tear film evaporates on the ocular surface to determine if meibomian glands are affected.
Testing is usually unnecessary unless the healthcare provider suspects the blepharitis is caused by a tumor or a bacterial infection.
Blepharitis treatment options
Eyelid hygiene is the foundation of blepharitis treatment. For patients with chronic blepharitis, eyelid hygiene will become a daily ritual for the rest of their lives. Topical antibiotics will nearly always be used for anterior blepharitis on the front of the eyelid, and eyelid massage will nearly always be advised for meibomian gland dysfunction. Other treatments such as topical steroids, oral antibiotics, and several new thermal, laser, or electrical treatments are available for certain blepharitis cases.
Home remedies
Daily eyelid hygiene is the standard treatment for blepharitis even when medications are advised or prescribed. A healthcare professional will usually give detailed instructions that involve regularly:
- Applying a warm compress to the eyelids to loosen dirt and oils
- Regularly washing the eyelid with diluted baby shampoo or over-the-counter eyelid washes
- Gently massaging the eyelids to help loosen any oils backed up in the eyelid’s oil glands
Patients with a mite (Demodex) infestation may be advised to wash the eyelid margins regularly with tea tree oil for several weeks, or apply prescription permethrin cream as directed, to reduce the amount of mites in the skin and pores of the eyes.
Medications
Diluted baby shampoo and eyelid washes are the universal method used to treat and prevent blepharitis flare ups. But a doctor may advise or prescribe topical corticosteroids or antibiotics, often together. Oral antibiotics may be required to treat stubborn cases of blepharitis or those caused by rosacea.
Other therapies
Ophthalmologists and dermatologists have a range of new tools that can help meibomian gland dysfunction. Thermal pulsation therapy (LipiFlow), and light burr therapy (BlephEx) both remove debris and crust blocking the eyelid’s oil glands. MiBo Thermoflo uses heat and a Maskin probe uses a small electrical current to stimulate the meibomian glands to produce and release oil. However, due to the cost and limited data on these therapies, it’s important to talk with your eye care provider before trying them.
Blepharitis medications
Treatment of blepharitis often involves more than one medication. Medications, however, only treat the symptoms.
Lid washes
The mainstay of blepharitis treatment is to keep the eyelid clean and reduce the number of bacteria on the eyelid and around the eye. During flare-ups, eyelid washing should be performed two to four times a day. Diluted baby shampoo applied with a clean washcloth or cotton swab is usually sufficient. For chronic blepharitis, an ophthalmologist may advise eyelid scrubs with saline or hypochlorous acid, a powerful disinfectant.
Lubricating eye drops
Depending on the cause, blepharitis can cause either excessive tearing or dry eyes. Meibomian gland dysfunction typically results in dry eye, so an optometrist or ophthalmologist will recommend using artificial tears throughout the day.
Topical antibiotics
Many cases of blepharitis are treated with topical antibiotic ointment or eye drops such as erythromycin or bacitracin. Topical antibiotics both reduce bacteria on the eyelid and significantly relieve symptoms. They should be applied right after washing the eyelid before bedtime.
Topical corticosteroids and immunosuppressants
For severe blepharitis, a healthcare provider may prescribe topical corticosteroids such as loteprednol to reduce swelling. Corticosteroids suppress the immune system. When applied to the eyelids, they block the formation of substances that cause redness and swelling. Some topical eye medications, such as Blephamide, contain both a steroid and antibiotic. For severe cases of chronic blepharitis, an ophthalmologist may prescribe topical immunosuppressants such as cyclosporine or tacrolimus. Both dramatically block the immune system response by interfering with the activation of white blood cells, the body’s front line in fighting infections.
Oral antibiotics
Oral tetracyclines or azithromycin are sometimes used to treat meibomian gland dysfunction in patients with hard-to-treat blepharitis. Both reduce swelling and bacteria, but azithromycin also stimulates the meibomian glands to produce more oils. Patients with rosacea may be put on a small weekly dose to prevent blepharitis flare-ups. Oral antibiotics will also be prescribed if any bacterial infection spreads to the eye.
What is the best medication for blepharitis?
Blepharitis has many causes. Some people experience the condition only rarely, and others live with chronic blepharitis. For this reason, there is no “best” medication for blepharitis, just the right combination of therapies for each patient to bring symptoms under control and prevent future flare-ups.
| Best medication for blepharitis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| OcuSoft HypoChlor (hypochlorous acid) | Eyelid wash | Topical | One spray on each eyelid and wipe off as needed | Redness, itching, burning |
| Ery (erythromycin) | Antibiotic | Topical | Rub pad over the affected area once in the morning and once at night after washing with soap and water and patted dry | Peeling, dryness, itching |
| Bacitracin | Antibiotic | Topical | Apply a small amount on the affected area twice daily and at bedtime | Itching, redness, rash |
| AzaSite (azithromycin) | Antibiotic | Eye drops | One drop in the affected eye twice daily for the first 2 days and then one drop in the affected eye once daily for 5 days | Irritation, redness, Itchiness, blurred vision |
| Tetracycline | Antibiotic | Oral | One 500 mg capsule twice per day | Nausea, vomiting, diarrhea, stomach pain, sun sensitivity |
| Minocin (minocycline) | Antibiotic | Oral | One 100 mg capsule every 12 hours taken with or without food | Dizziness, fatigue, itchy rashLoss of appetite, |
| Lotemax (loteprednol) | Corticosteroid | Eye drops | 1 or 2 drops into the conjunctival sac 4 times a day | Swelling, eye pain, foreign body feeling in the eye, burning, runny nose |
| Tobradex (tobramycin-dexamethasone) | Antibiotic and corticosteroid | Eye drops | 1 to 2 drops into the conjunctival sac every 4 to 6 hours | Eye pain, itching, swelling |
| Blephamide (sulfacetamide-prednisolone) | Antibiotic and corticosteroid | Eye drops | Two drops into the conjunctival sac every 4 hours during the daytime and at bedtime | Eye irritation, eye pain, swelling |
| Restasis (cyclosporine) | Immune suppressant | Eye drops | One drop in each eye every 12 hours | Eye pain, burning, irritation, redness |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on the nature and cause of the blepharitis, the patient’s medical condition, response to treatment, and allergies. Other possible side effects exist. This is not a complete list.
What are the common side effects of blepharitis medication?
Different classes of medications have different side effects. However, this is not a complete list, and you should consult with a healthcare professional for possible side effects and drug interactions based on your specific situation.
Lid washes and lubricating eye drops are generally safe medications with few and rarely-experienced side effects. Most side effects are confined to site reactions such as redness, irritation, itching, and allergic reactions.
Topical antibiotics are generally safe unless they are absorbed into the bloodstream. The most common side effects are site reactions such as swelling, redness, irritation, blistering, and itching.
Oral antibiotics like tetracyclines and azithromycin typically cause abdominal pain, intestinal problems, diarrhea, nausea, and loss of appetite. The most serious side effects of azithromycin, a macrolide antibiotic, involve hearing damage as well as potentially hazardous heart problems. With all antibiotics, topical and oral, allergic reactions are a potentially serious concern.
Because of potential side effects, topical steroids and immunosuppressants are only prescribed for a few days’ use in severe cases of blepharitis. Common side effects of corticosteroids include thinning skin, acne, eyelid drooping, and excessive tearing. Steroids that come in contact with the eye can cause blurred vision, burning, itching, and glaucoma. Cyclosporine and tacrolimus can cause serious side effects when taken orally, but topical versions are safer. Typical side effects include temporary site reactions such as burning, irritation, and redness.
What is the best home remedy for blepharitis?
The most universal treatment for blepharitis is home treatment. Effective eyelid hygiene consists of just three home remedies: warm compresses, lid washing, and lid massaging.
Use warm compresses
Apply warm compresses or a warm washcloth to the eyelids twice daily for 15 minutes. The temperature must be greater than 108 degrees but not so hot that it burns. The heat from the compress liquefies and loosens the oil in the meibomian glands. It also helps loosen dirt and crust along the eyelid margins.
Wash the eyelid
Immediately after applying a warm compress, wash the eyelids and eyelid margins either with diluted baby shampoo or lid scrubs. Use cotton swabs to carefully wash the eyelid margins. Saline or hypochlorous lid washes are useful if a bacterial infection is causing the problem. For any mite infestation, use diluted tea tree oil or tea tree oil shampoo instead. If your blepharitis is caused by seborrheic dermatitis, using dandruff shampoo on your scalp may help, but don’t use it on your eyelids or anywhere near your eyes.
Gently massage the eyelid
If your blepharitis is caused by meibomian gland dysfunction, a very gentle massage of the eyelid and eyelid margins will help push out oil backed up in the glands. You should do this right after applying warm compresses and washing the eyelids. The meibomian glands inside the eyelid are like tubes that run from the outer part of the eyelid to the eyelid margin where the oil comes out. Start at the end of the glands away from the lid margin and gently roll towards the edge of the eyelid. Also, rub along the lid margin with a washcloth or cotton swab to help unblock the glands.
Be careful with eye makeup
During a bout of blepharitis, avoid all eye makeup. To prevent future flare-ups, make sure to wash off all eye-makeup before bedtime. Eyeliner should not be applied to the back edges of the eyelids. It’s also a good idea to regularly replace eye make-up because of the risk of contamination.
Frequently asked questions about blepharitis
How long does blepharitis take to clear up?
Blepharitis has several causes, so some cases may take longer to resolve than others. Most treatments for acute blepharitis last for four to six weeks.
Can blepharitis be cured naturally?
Most cases of blepharitis can be resolved with good lid hygiene without resorting to prescription medications or medical procedures. However, blepharitis can be caused by many conditions including bacterial infections, mite infestations, scalp dandruff, rosacea, and allergies. These conditions may require medical treatment to help resolve or prevent blepharitis.
What ointment is good for blepharitis?
Blepharitis has many causes, so treatment will depend on the cause. In most cases, daily eyelid hygiene should be enough to resolve or prevent flare-ups. Topical antibiotics are used in many cases to both reduce bacteria and alleviate symptoms.
What can make blepharitis worse?
Active skin diseases such as rosacea, acne, or seborrheic dermatitis make blepharitis flare-ups more likely, as does contaminated eye makeup, allergen exposure, and cold and dry weather. During an active bout with blepharitis, eye makeup and allergens will worsen the condition.
What triggers blepharitis?
Blepharitis due to allergies—atopic blepharitis—can be triggered by allergens.
What happens if blepharitis is left untreated?
Most blepharitis flare-ups resolve without treatment. However, untreated blepharitis risks serious complications such as dry eye, the formation of styes or chalazia, or corneal damage.
Is blepharitis contagious?
Although blepharitis can be caused by infections, it is not contagious. The bacteria that cause infectious blepharitis and the mites that cause Demodex blepharitis live harmlessly on most people’s face and skin. These organisms can occasionally cause problems, such as blepharitis or folliculitis, but the infections are “caught” from organisms already living on the skin.
Does blepharitis worsen with age?
The risk of blepharitis increases with age, but the severity of symptoms is not age-related.
Does honey help blepharitis?
Honey, particularly manuka (Leptospermum) honey, has been studied in a number of small trials in a number of different products or formulations. These trials suggest honey may improve symptoms of dry eye and blepharitis, but no large trial of any single honey medication has yet been performed. Talk to your ophthalmologist about safe honey medications. Above all, avoid putting food-grade honey on or near your eyes. Honey can be sterilized by boiling it with saline, but there is a risk of other contaminants in the honey that could harm the eye.
Why is my eye producing so much mucus?
The “mucus” build-up typical of blepharitis is not actually mucus. Mucus production is a normal function of healthy eyes. The eye produces oils, water (tears), and mucus to keep the eye lubricated. Mucus sits right on the surface of the eye and primarily protects the eye from infection. Water above the mucus provides the lubrication and the oils that sit on the top prevent the water from evaporating. The mucus, oils, and tears on the eye are constantly being wiped away from the surface. Every time a person blinks, they remove excess mucus, water, and oils along with debris and bacteria. During the night, however, blinking stops. So extra water, oil, debris, and some mucus build up at the eyelid margin. This is normal. During an active flare-up of infectious blepharitis, this excess contains large amounts of bacteria, producing the “crusty” build-up typical of blepharitis.
Why does white stuff come out of my eyes?
White eye discharge is often a sign of an infection or eye irritant. Blepharitis, corneal sores, conjunctivitis, eyelid cellulitis, or foreign objects in the eye can all cause pus to be mixed in with the tears, oils, and mucus that normally discharge from the eye.