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Blepharitis

Published by Bupa's health information team, July 2008.

This factsheet is for people who have blepharitis, or who would like information about it.

Blepharitis is an inflammation on the edge of your eyelid. It usually affects both eyes, causing irritation and redness. It's a common condition, accounting for five percent of all eye problems. It can affect people of any age, although certain types of blepharitis are more common in old age (especially those affecting the meibomian glands).

• About blepharitis
• Symptoms of blepharitis
• Complications of blepharitis
• Causes of blepharitis
• Diagnosis of blepharitis
• Treatment for blepharitis
• Further information
• Questions and answers
• Video
• Related topics
• Sources

About blepharitis

Blepharitis is a chronic condition which causes the edge of your eyelid to become red and inflamed. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person's life. The term chronic refers to time, not how serious a condition is.

Blepharitis can affect the base of your eyelashes (anterior blepharitis) or the meibomian glands in your eyelid (posterior blepharitis). Your meibomian glands are located just behind your eyelashes. They help to keep your eyes moist by preventing the watery layer on the surface of your eyes (tears) from evaporating. They do this by producing an oily film over the tears.

Symptoms of blepharitis

The symptoms of blepharitis often come and go, and usually affect both eyes. Symptoms include:

• sore eyelids, which may also be swollen
• a gritty, burning or itching feeling in your eyes
• eyelids sticking together, especially in the morning
• crusting on your eyelashes
• scaly or greasy eyelids
• difficulty wearing your contact lenses

Complications of blepharitis

Blepharitis is not a serious condition. Your vision is rarely affected, but it can lead to further problems in your eye area.

Conjuctivitis

This is an inflammation of your conjunctiva, the transparent layer that covers the white of your eye and lines your eyelids. The bacteria causing your blepharitis can produce substances that get onto the surface of your eye and cause inflammation.

Conjunctival cysts and concretions

These are small fluid-filled blisters or fatty lumps on your conjunctiva. They don't usually cause any harm.

Chalazion

This is when one of the meibomian gland ducts in your eyelid becomes blocked leaving a pea-sized lump, similar to a stye. Occasionally it can put pressure on your cornea (the front part of the eye that covers the pupil) causing it to change shape (astigmatism).

Keratitis

This is an inflammation of the cornea, you may also have some ulcers in this area. It usually affects middle-aged and elderly people. The symptoms come and go frequently.

Trichiasis

This is when your eyelashes grow inwards towards your eye.

Eyelid scarring

This usually only occurs if your blepharitis is severe or you have frequent bouts of symptoms. It may result in your eyelashes falling out, and cause the edge of your eyelid to become a thicker, irregular shape.

Dry eye syndrome

This is when you don't have enough tears to keep your eyes moist, or the quality of your tears isn't good enough to keep your eye evenly wet. It can cause irritation and redness in your eyes.

Causes of blepharitis

The exact causes of blepharitis aren't known at present, but it's thought to be related to the following.

Staphylococcus infection

Staphylococcus is a bacterium which causes inflammation on the front edge of your eyelid, at the base of your eyelashes (anterior blepharitis). It's sometimes called staphylococcal blepharitis.

Meibomianitis

This is when the meibomian glands behind your eyelashes become infected and blocked (posterior blepharitis). You are more likely to have this if you have skin conditions such as rosacea and psoriasis.

Seborrhoeic dermatitis

Seborrhoeic dermatitis, a form of eczema, is a condition in which you have rashes and inflammation on your skin. It can affect the area around your eyes and eyelids causing blepharitis. This is usually called seborrhoeic blepharitis, and causes inflammation of the front edge of your eyelid (anterior blepharitis). Occasionally, you can get meibomian seborrhoea (when your meibomian glands produce too much oily liquid) together with seborrhoeic dermatitis. This can cause oily, foamy liquid to gather at the rim of your eyelid.

Irritants

Blepharitis has been linked with exposure to chemical fumes, smoke, smog and other irritants.

Diagnosis of blepharitis

Your GP or optometrist (a healthcare professional who examines eyes, tests sight and dispenses glasses and contact lenses) can diagnose whether you have blepharitis. He or she will ask about your symptoms and examine your eyes. Usually what is causing your blepharitis can be determined by your symptoms.

It's unlikely that you will be referred to a specialist for treatment - your GP or optometrist will treat and monitor your condition.

Treatment for blepharitis

Blepharitis can't be cured, but symptoms can be controlled. This means that long-term treatment is often needed.

Self-help

It's important to keep the area around your eyelids clean and clear of any crusting or stickiness. You can do this using a small amount of baby shampoo diluted in water. Apply it with a cotton bud or your fingertips along the edge of your eyelid and rinse. You should to this at least once a day. Alternatively, you can use lid wipes or scrubs - you can buy these from your pharmacist or optometrist.

A hot compress followed by an eye massage, can help to remove any blockages that may be causing your blepharitis, especially if it's caused by problems with your meibomian glands. Use a towel soaked in hot water to make a compress. The compress should feel comfortable on your skin; it shouldn't be scalding hot. Hold the compress against your eyelid for five to 10 minutes. This will warm any blockages with oily fluid trapped inside. Next, massage your eyelid by gently rolling your finger in a circular motion around the affected area. You should do this for about a minute. The massage will help to remove any blockages and release trapped fluids.

You should clean your eyelids and use a hot compress twice a day until your symptoms have gone. Then do it once daily to prevent symptoms coming back.

Medicines

Antibiotic medicine

If your eyelids are inflamed and painful, your GP will prescribe an antibiotic ointment, such as chloramphenicol ointment (eg Chloromycetin). Apply this to the edge of your eyelid using your fingertip or a cotton bud at night, after you have cleaned the area.

If your symptoms are severe or keep coming back, your GP may prescribe antibiotic tablets, such as oxytetracycline or tetracycline. He or she will ask you to come back after about six weeks to check your progress.

Topical steroids

A topical steroid, such as hydrocortisone acetate (eg Neo-Cortef) sometimes together with antibiotics (eg Maxitrol), may occasionally be prescribed for a short time. This helps to reduce inflammation on your eyelids.

Artificial tears

Blepharitis can cause your eyes to become very dry (dry eye syndrome). You can treat this using eye drops called artificial tears, such as Celluvisc or GelTears. Initially you should apply them hourly throughout the day, then as you need them. You can buy artificial tears from your pharmacist. Always read the patient information that comes with your medicine.

If your blepharitis is caused by an underlying condition such as rosacea or psoriasis, you will need treatment for these as well.

Further information

The College of Optometrists
www.college-optometrists.org

Video

See our video about blepharitis:

How should I clean & care for my eyelids if I have an infection in them?

Related topics

• Astigmatism
• Chalazion
• Conjunctivitis
• Eczema
• Psoriasis
• Stye

Sources

• Blepharitis. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 10 April 2008
• Khaw PT and Elkington AR. ABC of Eyes. London: BMJ Publishing Group, 2002
• Blepharitis. GP Notebook. www.gpnotebook.co.uk, accessed 10 April 2008
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007
• Blepharitis, Adult. eMedicine. www.emedicine.com, accessed 10 April 2008
• Hordeolum and chalazion treatment: the full gamut. Skorin L. www.optometry.co.uk, accessed 10 April 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2008