Blepharitis

Blepharitis symptoms and signs include:

• Watery eyes
• Red eyes
• A gritty, burning or stinging sensation in the eyes
• Eyelids that appear greasy
• Itchy eyelids
• Red, swollen eyelids
• Flaking of the skin around the eyes
• Crusted eyelashes upon awakening
• Eyelid sticking
• More frequent blinking
• Sensitivity to light
• Eyelashes that grow abnormally (misdirected eyelashes)
• Loss of eyelashes

When to see a doctor

If you have blepharitis symptoms and signs that don’t seem to be improving despite good hygiene — regular cleaning and care of the affected area — make an appointment with your doctor.

The exact cause of blepharitis isn’t clear. It may be associated with one or more factors, including:

• Seborrheic dermatitis — dandruff of the scalp and eyebrows
• A bacterial infection
• Clogged or malfunctioning oil glands in your eyelids
• Rosacea — a skin condition characterized by facial redness
• Allergies, including allergic reactions to eye medications, contact lens solutions or eye makeup
• Eyelash mites or lice

If you have blepharitis, you may also experience:

• Eyelash problems. Blepharitis can cause your eyelashes to fall out or grow abnormally (misdirected eyelashes).
• Eyelid skin problems. Scarring may occur on your eyelids in response to long-term blepharitis. Or the eyelid edges may turn inward or outward.
• Excess tearing or dry eyes. Abnormal oily secretions and other debris shed from the eyelids, such as flaking associated with dandruff, can accumulate in your tear film — the water, oil and mucus solution that forms tears. Abnormal tear film interferes with the healthy lubrication of your eyelids. This can irritate your eyes and cause symptoms of dry eyes or excess tearing.
• Difficulty wearing contact lenses. Because blepharitis can affect the amount of lubrication in your eyes, wearing contact lenses may be uncomfortable.
• Sty. A sty is an infection that develops near the base of the eyelashes. The result is a painful lump on the edge (usually on the outside part) of your eyelid. A sty is usually most visible on the surface of the eyelid.
• Chalazion. A chalazion occurs when there’s a blockage in one of the small oil glands at the margin of the eyelid, just behind the eyelashes. The gland can become infected with bacteria, which causes a red, swollen eyelid. Unlike a sty, a chalazion tends to be most prominent on the inside of the eyelid.
• Chronic pink eye. Blepharitis can lead to recurrent bouts of pink eye (conjunctivitis).
• Injury to the cornea. Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on your cornea. Insufficient tearing could predispose you to a corneal infection.

You’re likely to start by seeing your family doctor or a general practitioner. If your doctor suspects you may have an eyelid problem, such as blepharitis, you may be referred to an eye specialist (optometrist or ophthalmologist).

Because appointments can be brief, it’s a good idea to be prepared for your appointment. Here’s some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if you need to do anything in advance, such as remove your contact lenses.
• List any symptoms you’re experiencing, including any that may seem unrelated to blepharitis.
• Make a list of all medications, vitamins or supplements that you’re taking.
• List questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. List your questions from most important to least important in case time runs out. For blepharitis, some basic questions to ask your doctor include:

• What is likely causing my symptoms?
• What are other possible causes for these symptoms?
• Are there general medical disorders that can cause this problem?
• What kinds of tests will I need?
• What treatments are available, and which do you think would be the best treatment for me?
• Is this condition usually temporary or long lasting? After treatment, will it come back again?
• Is my blepharitis contagious?
• Should I see a specialist?
• Is there a generic alternative to the medicine you’re prescribing?
• Do you have any brochures or other printed material that I can take with me?
• What websites do you recommend visiting for more information?
• Can I continue to wear contact lenses?
• Do I need to take special care cleaning my contact lenses and my carrying case?
• Will I need a follow-up visit? If so, when?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask additional questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first notice your symptoms?
• Do your symptoms come and go, or do you always have them?
• Do your symptoms occur at a particular time of day?
• Have you been wearing contact lenses?
• Have you changed cosmetic brands recently?
• Have you changed soap or shampoo brands recently?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Has anyone close to you had a recent eye infection?
• Have you ever had any eye diseases, eye surgeries or eye injuries?
• Do you have other diseases or conditions?

What you can do in the meantime

As you wait for your appointment, you may find some relief from eye irritation by gently washing your eyelids a few times each day. To wash your eyelids:

• Apply a warm washcloth to your closed eyelids for up to five minutes.
• Gently rub your closed eyelids with a diluted solution of baby shampoo. Use a clean washcloth or clean fingers. You may need to hold the lid away from the eye while you are using the wash cloth to rub along the lash margin. This may require several minutes of gentle rubbing to remove the scales.
• Rinse your eyes thoroughly with warm water.

Avoid anything that irritates your eyes, such as eye makeup and contact lenses.

Tests and procedures used to diagnose blepharitis include:

• Examining your eyelids. Your doctor will carefully examine your eyelids and your eyes. He or she may use a special magnifying instrument during the examination.
• Swabbing skin for testing. In certain cases, your doctor may use a swab to collect a sample of the oil or crust that forms on your eyelid. This sample can be analyzed for bacteria, fungi or evidence of an allergy.

Self-care measures, such as washing your eyes and using warm compresses, may be the only treatment necessary for most cases of blepharitis. If that is not enough, your doctor may suggest prescription treatments, including:

• Medications that fight infection. Antibiotics applied to the eyelid have been shown to provide relief of symptoms and resolve bacterial infection of the eyelids. These are available in a variety of forms, including eyedrops, creams and ointments. If you don’t respond to topical antibiotics, your doctor may suggest an oral antibiotic.
• Medications to control inflammation. Steroid eyedrops or ointments may help control inflammation. Your doctor may prescribe both antibiotic and anti-inflammatory drugs.
• Medications that affect the immune system. Topical cyclosporine (Restasis) is a calcineurin inhibitor that has been shown to offer relief of some signs and symptoms of blepharitis.
• Treatments for underlying conditions. Blepharitis caused by seborrheic dermatitis, rosacea or other diseases may be controlled by treating the underlying disease.

Blepharitis rarely disappears completely. Even with successful treatment, the condition frequently is chronic and requires daily attention with eyelid scrubs. If you don’t respond to treatment, or if you’ve also lost eyelashes or only one eye is affected, the condition could be caused by a localized eyelid cancer.

Self-care measures such as the following may be the only treatment necessary for most cases of blepharitis.

Clean your eyes daily

If you have blepharitis, follow this self-care remedy two to four times a day during flare-ups and once or twice a day after the condition is under control:

• Apply a warm compress over your closed eye for several minutes to loosen the crusty deposits on your eyelids.
• Immediately afterward, use a washcloth moistened with warm water and a few drops of diluted baby shampoo to wash away any oily debris or scales at the base of your eyelashes. Use a different clean cloth for each eye.
• In some cases, you may need to be more deliberate about cleaning the edge of your eyelids where your eyelashes are located. To do this, gently pull your eyelid away from your eye and use the washcloth to gently rub the base of the lashes. This helps avoid damaging your cornea with the washcloth. Ask your doctor whether you should use a topical antibiotic ointment after cleaning your eyelids in this way.
• Rinse your eyelids with warm water and gently pat it dry with a clean, dry towel.

It also may be a good idea to stop using eye makeup when your eyelids are inflamed. Makeup can make it harder to keep your eyelids clean and free of debris. Also, it’s possible that makeup could reintroduce bacteria to the area or cause an allergic reaction.

Lubricate your eyes

Try over-the-counter artificial tears. These lubricating eyedrops may help relieve dry eyes.

Control dandruff and mites

If you have dandruff that’s contributing to your blepharitis, ask your doctor to recommend a dandruff shampoo. Using a dandruff-controlling shampoo may relieve your blepharitis signs and symptoms. Using tea tree shampoo on your eyelids each day may help deal with mites. Or try gently scrubbing your lids once a week with a 50 percent tea tree oil, which is available over-the-counter.

No alternative medicine treatments have been found to conclusively ease the symptoms of blepharitis. However, a diet rich in omega-3 fatty acids or supplements containing omega-3 fatty acids may be helpful for blepharitis associated with rosacea. Omega-3 fatty acids are found in foods such as salmon, tuna, trout, flaxseed and walnuts.