Blepharitis Symptoms And Treatment

5 min read

Blepharitis is sometimes called “dandruff of the eyelids.” While people use this phrase, it is not the same thing. Under the microscope, an ophthalmologist may see flaky debris that looks similar to dandruff. The difference is that blepharitis is caused by a problem in the meibomian glands of your eyelids. 

Symptoms Of Blepharitis

Blepharitis has a wide variety of symptoms. In some patients, blepharitis causes no symptoms. In fact, patients may not know that they have blepharitis or meibomian gland dysfunction until they are told this by an eye doctor. As blepharitis get worse, the symptoms of blepharitis will also get worse. One of the most common symptoms of blepharitis is itchy eyes. Some patients can also experience watery eyes and eyelid crusting. Eyelid crusting is usually more common in the morning after waking up. As blepharitis gets worse it can cause more severe symptoms like burning in the eyes, light sensitivity, foamy tears, severe dry eye, or even swollen red eyelids. While blepharitis itself is not dangerous, severe and chronic blepharitis can be very frustrating and can severely decrease your quality of life. It can also cause other problems like chronic dry eye and even blurry vision. 

Cause Of Blepharitis

When the meibomian glands of the eyelid become clogged, this results in an irritation and inflammation of the eyelid skin called blepharitis. Blepharitis is usually separated into two categories. 

The first type is anterior blepharitis. Anterior means in the front, and thus, anterior blepharitis affects the part of the eyelid where the eyelashes are. Anterior blepharitis is usually caused by bacteria called Staphylococcus. Anterior blepharitis is more likely if you have poor lid hygiene, scalp or eyebrow dandruff, or allergies.

The second type of blepharitis happens more towards the back of the eyelid, and it is called posterior blepharitis. This is when the oil glands (meibomian glands) of the eyelid are involved. This is the part of the eyelid that touches the eyeball. Under a microscope it is easy to distinguish anterior vs posterior blepharitis. But they are very close together practically speaking. Posterior blepharitis can happen to anyone, but it is more common in patients who have rosacea or scalp dandruff. 

Is Blepharitis Contagious?

No, blepharitis is not contagious. 

Treating Blepharitis

While there is no cure for blepharitis, there are many ways to treat it. Eyelid hygiene is important in reducing blepharitis. This involves two things: warm compresses and soapy lid scrubs. When heat is applied to the eyelid, it helps the meibomian glands to open and express any oil that may be stuck. A heat mask can be very helpful in treating blepharitis.

After this debris leaves the glands, it needs to be washed away from the eyelid. That is why the lid scrubs are recommended after the heat. Use a mild soap and make a small lather in the palm of your hand. Use one or two fingers to gently clean the margin of your eyelid and eyelashes. Many doctors will recommend this schedule two times a day. If you have untreated dandruff, it could be contributing to your blepharitis. Use an anti-dandruff shampoo to treat your dandruff as well. Artificial tears do not directly help blepharitis. Because blepharitis can also cause dry eye, artificial tears can be helpful to patients who are also having dry eye symptoms.

Risk Factors For Blepharitis

Related: Eyelash Shampoo

All people have some bacteria on their eyelids. This is totally normal. Some people will either have more bacteria on their eyelids than others, or they are just more sensitive to blepharitis. Especially if they have other conditions like rosacea or meibomian gland dysfunction, they are more likely to have blepharitis. It is also important to clean your eyelids regularly. When people wash their face, they sometimes forget to pay attention to their lids and lashes. This can cause excessive bacteria to build up in those locations. 

Diagnosis Of Blepharitis

The best way to know if you have blepharitis is to see an eye doctor. Any ophthalmologist will be able to diagnose blepharitis by asking you about your symptoms as well as by examining your eye and eyelids. This exam is usually done at the slit lamp. In some cases of mild blepharitis, diagnosis can also be done via telemedicine through a limited exam and asking about your symptoms. It is important to see an in-person ophthalmologist in the future if you opt for a telemedicine exam for your blepharitis so that the in-person eye doctor can also evaluate the other parts of your eye. 

Sources:

Amescua G, Akpek EK, Farid M, Garcia-Ferrer FJ, Lin A, Rhee MK, Varu DM, Musch DC, Dunn SP, Mah FS; American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019 Jan;126(1):P56-P93. doi: 10.1016/j.ophtha.2018.10.019. Epub 2018 Oct 23. PMID: 30366800.

https://pubmed.ncbi.nlm.nih.gov/30366800/

Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database Syst Rev. 2012 May 16;2012(5):CD005556. doi: 10.1002/14651858.CD005556.pub2. PMID: 22592706; PMCID: PMC4270370.

https://pubmed.ncbi.nlm.nih.gov/22592706/

Onghanseng N, Ng SM, Halim MS, Nguyen QD. Oral antibiotics for chronic blepharitis. Cochrane Database Syst Rev. 2021 Jun 9;6(6):CD013697. doi: 10.1002/14651858.CD013697.pub2. PMID: 34107053; PMCID: PMC8189606.

https://pubmed.ncbi.nlm.nih.gov/34107053/

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