Blepharitis is an inflammation of the eyelids. It usually affects the edges (margins) of the eyelids. It is not usually serious, but may become an uncomfortable, irritating problem. Blepharitis is typically chronic (persistent). Both eyes are usually affected.

What causes blepharitis?

There are three main types of blepharitis:

Staphylococcal blepharitis

This type of blepharitis is thought to be caused by a bacterium (germ) called staphylococcus.

Seborrhoeic blepharitis

Seborrhoeic blepharitis is closely associated with a skin condition called seborrhoeic dermatitis. In seborrhoeic dermatitis, the affected skin becomes more oily and can become scaly. Seborrhoeic dermatitis typically causes bad dandruff and sometimes a rash, commonly on the face and upper body.

Meibomian blepharitis

The tiny meibomian glands in the eyelids lie just behind the eyelashes. They make a small amount of oily fluid which comes out on the inside of the eyelids next to the eye. This oily fluid forms the outer layer of the tear film which lubricates the front of the eye. People with meibomian blepharitis are thought to have a slight problem with their meibomian glands and the fluid they produce.

People with blepharitis tend to have flare-ups of symptoms from time to time. As mentioned, blepharitis is usually a long-term (chronic) problem.

What are the symptoms of blepharitis?

  • The main symptom is sore eyelids.
  • The eyelids may look inflamed.
  • The eyes may become sticky with discharge.
  • One or more of the tiny glands of the eyelids (meibomian glands) may block and fill with an oily fluid.

What are the possible complications of blepharitis?

Complications are uncommon. They include:

  • Chalazion (meibomian cyst). This is a painless swelling, most prominent on the inside of the eyelid. It is due to a blocked meibomian gland.
  • Stye. This is a painful infected swelling most prominent on the outside of the eyelid. It is due to an infection of the follicle (root) of an eyelash.
  • Loss of eyelashes (madarosis).
  • Misdirection of eyelashes towards the eye (trichiasis).
  • Depigmentation of the eyelashes (poliosis).
  • Eyelid may turn inwards against the eyeball (entropion) or outwards (ectropion).
  • Conjunctivitis (inflammation of the front of the eye).
  • Corneal inflammation (keratitis), ulceration, and scarring. This complication is rare but serious as it can affect sight.

What is the treatment for blepharitis?

The main treatment is regular eyelid hygiene. Other treatments that may be needed include antibiotics, steroid creams.

Regular eyelid hygiene

This is the most important part of treatment and prevention of blepharitis. The aim is to soothe the eyelids, unplug any blocked meibomian glands and clear out any stagnant oily secretions from these glands.

  • The traditional method is to press on the eyelids gently with a cloth soaked in very warm water for 5-10 minutes.
  • Massage the eyelids immediately after applying the warmth. Massaging helps to push out the oily fluid from the tiny meibomian glands. Massaging should neither to be too gentle nor too firm. It should be relatively comfortable and you should not press hard enough to actually hurt your eyeball under the closed lids.
  • After warmth and massage, clean the eyelids. Simply washing the eyelids with cooled water that has recently been boiled (or preserved water for contact lens wearers) is probably as effective as anything else.
  • You should do the above routine - warmth, massage, and clean - at least twice a day until symptoms settle.

Antibiotic treatments

Antibiotic eye ointment or drops may be advised for a while if an eyelid becomes infected.
Rubbing your eyelids may make inflammation worse, so try to avoid doing this.

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