Blepharitis: Symptoms, Causes & Treatment

Blepharitis occurs when the eyelids become irritated and inflamed. 

This may result in swollen, red eyelids that can cause an uncomfortable stinging or burning sensation along with crusty eyelashes. Watery or overly dry eyes, sensitivity to light, and blurry vision are also common side effects. 

Several diseases, skin conditions, and other factors can cause blepharitis. There are various treatments for blepharitis, including antibiotics, home remedies, and good hygiene habits.

Types of Blepharitis

There are two main types of blepharitis that are classified depending on the location of the affected area. Some people can also experience both types, which is known as mixed blepharitis.

Anterior Blepharitis

Anterior blepharitis occurs on the outside of the eyelids and on the eyelashes. It is divided into two types that are based on how the blepharitis is caused: staphylococcal and seborrheic. 

Staphylococcal anterior blepharitis is induced by the bacterium Staphylococcus. Aside from bacteria, a type of skin disease known as seborrheic dermatitis can also cause anterior blepharitis, resulting in similar symptoms.

Posterior Blepharitis

Posterior blepharitis occurs on the meibomian glands and gland orifices, which are near the inner edge of the eyelid. This is caused by the glands in the eyelids not producing enough oil. The ensuing symptoms of posterior blepharitis are the same as anterior blepharitis. 

Mixed Blepharitis

Mixed blepharitis is when both anterior and posterior blepharitis occur in the same person simultaneously.

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Blepharitis Symptoms

Symptoms of both anterior and posterior blepharitis include the following: 

• Dry and red eyes
• Pain or discomfort
• Mild sensitivity to light
• Flaky eyelashes
• Persistent inflammation of the eyelids

If left untreated, further serious complications can develop in some cases. 

Loss of or abnormally positioned eyelashes can also occur during blepharitis, depending on the severity of the case. 

Symptoms are usually worse in the beginning of the day and get milder as the day progresses. 

Causes

Viruses, fungi, and parasites can all lead to anterior blepharitis, but it is mainly caused by having too much bacteria on the eyelids and eyelashes. 

Bacterium is often naturally present in various places on the body and can also enter through a laceration or a bug bite. Poor hygiene habits can increase the number of bacteria, as can wearing contact lenses. 

Posterior blepharitis is caused by having clogged or irritated oil glands, which is usually due to meibomian gland dysfunction (MGD), a common eye condition.

Risk Factors

There are several risk factors that increase a person’s odds of developing the condition. These can include the following:

• Seborrheic dermatitis
• Rosacea
• Poor hygiene 
• Allergies
• Diabetes
• Certain eye makeups
• Meibomian gland dysfunction (MGD)

Complications & Associated Conditions

There is no cure for blepharitis, but it can be managed with good hygiene and prescribed treatments. If left untreated, blepharitis can result in further complications. 

A chalazion (a small, painless lump) can form on the edge of the eyelid, which is painless and can usually be treated at home. 

A stye can also develop from blepharitis. A stye looks similar to a chalazion, but it can be painful. Styes usually disappear on their own. 

Conjunctivitis (pink eye) is another less severe complication, but it can persist and become chronic if left untreated.

A more serious condition associated with blepharitis is keratitis, or a corneal ulcer. This is when a crater-like sore develops on the cornea of the eye, causing pain, red eyes, swelling, blurry vision, and excess tears. Typically, a physician can treat keratitis with antibiotics, but some cases necessitate a corneal transplant.

Diagnosing Blepharitis

Diagnosing both anterior and posterior blepharitis is moderately simple. A patient who starts noticing some of the aforementioned symptoms may suspect they have the condition, but it’s wise to see an eye doctor for confirmation. 

The doctor can closely examine the eyelids and eyes to properly diagnose blepharitis. In certain cases, a doctor may also test a sample of the oil or eyelash crust to determine if a bacterium, fungus, or allergy is causing the issue. 

Treatment of Blepharitis

Although blepharitis never completely goes away, there are several treatments and remedies to help diminish the symptoms and lessen the severity of the condition. 

Simply practicing good hygiene and certain home remedies may be all that is needed for mild cases. This can include wetting a washcloth with warm water and pressing it on the eyelids, cleaning the eyelids with non-irritating soap and water, and avoiding eye makeup.

In more severe cases, medical intervention is necessary to treat blepharitis. A physician can prescribe gels or ointments that can be directly applied to the eyelids. 

Steroid or antibiotic eye drops can also be applied to control inflammation and ease symptoms. If topical remedies don’t work or are not needed, oral antibiotics can also be utilized. 

Lifestyle choices and habits can also help to alleviate blepharitis or even prevent it in the first place. Keeping your face and hands clean is very important. Try not to touch your face and eyes. Wearing glasses instead of contacts and not sleeping with eye makeup on can also help. 

These easy hygienic practices should also be carried out by people who are not currently experiencing symptoms to prevent future cases of blepharitis.

Blepharitis for Contacts or Glasses Wearers 

People who regularly wear contact lenses have a better chance of developing blepharitis than non-contact wearers. 

In order to insert or remove the lenses, a person touches their eyes more than someone who does not wear contacts. This increases the risk of spreading bacteria. Leaving contacts in for too long is also a contributing factor. 

People who regularly wear glasses are also at a slightly higher risk of bacterial infection. If they are not cleaned on a regular basis, a pair of glasses can carry around bacteria and easily expose it to the eyelid.

When to See a Doctor

A person with blepharitis symptoms should see a doctor if their condition worsens and if home remedies are ineffective. Typically, just practicing good hygiene habits and cleaning the eyes and eyelids can help symptoms subside. 

Prescribed eye drops or medications administered by a doctor are the best way to help severe cases. People experiencing increasing pain, associated headaches, or blurred vision should also seek immediate medical assistance.

References

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2. Blepharitis. (February 2022). StatPearls.

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4. Conjunctivitis: A Systematic Review. (July 2020). Journal of Ophthalmic & Vision Research.

5. Contact Lenses and Associated Anterior Segment Disorders: Dry Eye Disease, Blepharitis, and Allergy. (2008.) Immunology and Allergy Clinics of North America.

6. Diagnosis and Management of Blepharitis: An Optometrist’s Perspective. (August 2016). University of Missouri-St Louis College of Optometry.

7. Keratitis. (February 2022). StatPearls.

8. Meibomian Gland Disease: The Role of Gland Dysfunction in Dry Eye Disease. (November 2017). Ophthalmology.

9. Rosacea. (March 1987). University of Genoa Department of Dermatology.

10. Seborrheic Dermatitis. (May 2022). StatPearls.

11. Staphylococcus, Medical Microbiology. (1996.) University of Texas Medical Branch at Galveston.