Blepharitis

What causes blepharitis

Anterior blepharitis (front of the lid margin)

• Staphylococcal blepharitis: an overreaction to staph bacteria that normally live on the skin. Causes hard crusts around the lashes, redness and sometimes lash loss.
• Seborrheic blepharitis: linked to seborrheic dermatitis (dandruff). Causes greasy flakes on the lashes and often flaking of the scalp and eyebrows.
• Demodex blepharitis: caused by tiny mites that live in eyelash follicles. Cylindrical "collarettes" of debris around the base of the lashes are a hallmark. It is more common with age.

Posterior blepharitis

Caused by meibomian gland dysfunction (MGD). The meibomian glands along the inner lid edge make the oily layer of the tear film. When they block or produce thick oil, tears evaporate too fast and the lids become inflamed. MGD is the most common cause of evaporative dry eye.

Associated conditions

• Rosacea: ocular rosacea commonly causes posterior blepharitis
• Allergies and eczema around the eyes
• Contact lens wear and eye makeup
• Some medicines, such as isotretinoin and certain cancer drugs

Symptoms

• red, swollen eyelid edges
• crusts, flakes or "dandruff" at the base of the eyelashes
• itchy, burning or stinging eyelids
• gritty, sandy feeling in the eyes
• watery or dry eyes
• lids stuck together on waking
• frothy tears
• light sensitivity
• blurred vision that clears with blinking

Symptoms usually affect both eyes and come and go in flares.

Complications

• Dry eye: blepharitis and dry eye often feed each other
• Styes: painful infected lumps at the lash line
• Chalazion: a painless lump from a blocked oil gland
• Eyelash problems: loss, whitening or misdirected lashes (trichiasis)
• Conjunctivitis: recurrent red eyes
• Corneal inflammation: small ulcers or inflammation at the edge of the cornea (marginal keratitis), which needs medical treatment
• Contact lens intolerance

Diagnosis

An optometrist or ophthalmologist diagnoses blepharitis by examining the lid edges, lashes and tear film with a slit lamp microscope. They look for crusts, collarettes, blocked glands with capped openings, thick oil when the lids are pressed, and the stability of the tear film. Swabs are rarely needed. A biopsy is done only if one lid is unusually thickened or does not respond, to rule out a rare eyelid cancer.

Treatment

Daily lid hygiene (the foundation)

1. Warm compress: hold a warm, clean washcloth or a microwavable eye mask on closed eyes for 5 to 10 minutes to soften crusts and melt thick oil. Rewarm as needed. It should feel warm, not hot.
2. Lid massage: gently roll a fingertip along the lid toward the lashes, top lid downward and bottom lid upward, to express oil.
3. Clean the lid margins: using a cotton pad or clean fingertip with diluted baby shampoo (a few drops in a cup of warm water) or a commercial lid cleanser or wipe, gently rub along the base of the lashes.
4. Rinse with clean water and pat dry.

Do this once or twice a day while symptoms are active, then a few times a week to prevent flares. Improvement takes 2 to 4 weeks.

Additional treatments

• Lubricating eye drops: preservative-free artificial tears for dryness
• Antibiotic ointment such as erythromycin or bacitracin applied to the lid margins for a few weeks in staphylococcal blepharitis
• Oral antibiotics such as doxycycline or azithromycin at low dose for several weeks for posterior blepharitis and rosacea. Doxycycline is avoided in pregnancy and young children
• Demodex treatment: lotilaner eye drops are FDA-approved for Demodex blepharitis. Tea tree oil products are an alternative but can irritate
• Short courses of steroid drops for significant inflammation, under eye doctor supervision only
• In-office treatments for MGD, such as thermal pulsation and intense pulsed light, in persistent cases
• Omega-3 supplements: evidence for dry eye is mixed

Practical tips

• pause eye makeup during flares and remove it fully every night
• replace eye makeup every 3 months
• treat scalp dandruff with an anti-dandruff shampoo
• avoid rubbing your eyes
• follow contact lens hygiene closely or switch to glasses during flares

Outlook

Blepharitis is usually chronic, with flares and calmer periods. It rarely causes lasting harm to vision. Most people control it well with a sustainable lid care routine and occasional extra treatment during flares.

Frequently asked questions

What causes blepharitis?

Blepharitis is caused by bacteria on the eyelid edges, dandruff-like skin conditions, Demodex mites, or blocked oil glands in the lids (meibomian gland dysfunction). Rosacea, allergies and dry eye are commonly linked.

What is the best treatment for blepharitis?

Daily warm compresses, gentle lid massage and cleaning the lid margins are the most effective treatment. Lubricating drops help dryness. A doctor may add antibiotic ointment, oral antibiotics, or anti-mite drops for specific types.

Is blepharitis contagious?

No. Blepharitis is an inflammatory condition, not a contagious infection. You cannot catch it from or give it to someone else, though you should still avoid sharing towels or eye makeup.

Can blepharitis be cured?

It usually cannot be cured permanently, but it can be controlled. Most people need to keep up lid hygiene several times a week even when symptoms are quiet, to prevent flares.

How long does a blepharitis flare last?

With daily lid hygiene, symptoms usually improve within 2 to 4 weeks. Flares can return when lid care lapses, during allergy seasons, or with rosacea flares.