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 which can cause similar symptoms:
staphylococcal blepharitis, seborrhoeic blepharitis and meibomian
blepharitis.
Staphylococcal blepharitis
This type of
blepharitis is thought to be caused by a bacterium (germ) called
staphylococcus. The staphylococcus bacterium commonly lives in low
numbers on the skin without doing any harm. However, in some people, it
seems that this bacteria causes a localised infection of the eyelids to
cause blepharitis. Why this may occur in some people and not most
people is not clear.
Seborrhoeic blepharitis
This type is closely
associated with a skin condition called seborrhoeic dermatitis. In
seborrhoiec 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. The underlying
cause of seborrhoeic dermatitis is not clear. A yeast germ called Malassezia furfur
is involved. However, it is not just a simple skin infection and it is
not contagious (you cannot 'catch' this condition from others). This
yeast germ lives in the sebum (oil) of human skin in most adults. In
most people it does no harm. But some people seem to 'react' to this
germ in some way which causes inflammation.
Meibomian blepharitis — often called meibomian gland dysfunction.
The
tiny meibomian glands in the eyelids lie just behind the eyelashes. You
have about 50 glands on the upper eyelids and 25 on the lower eyelids.
They make a small amount of oily fluid (oily secretions) which comes
out on the back 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 which may lead
to eyelid inflammation. (This also explains why people with meibomian
blepharitis often have dry eyes as the fluid they make may not be
adequate to lubricate the eye.)
Combinations of the above
In practice, it is
often not possible to tell the difference between the above causes.
Indeed, seborrhoeic blepharitis commonly occurs together with meibomian
blepharitis. And, skin which is inflamed anyway is more likely to
become infected by the staphylococcus. So, all three causes may
contribute to many cases with the main cause varying from case to case.
A vicious circle may play a part
Blepharitis
tends to 'flare-up' for a time and then ease off in severity. If you
have blepharitis, you are likely to always have a tendency to have it
as each of the above causes tends to be a long-term problem. Sometimes
a 'vicious cycle' may play a part. For example, your eyelids may become
slightly inflamed and itchy, but not too bad. You may then rub them -
which makes the inflammation worse. This in turn can lead to your
eyelids becoming sore. You may then keep rubbing them further, which
leads to more inflammation, and so on.
What are the symptoms of blepharitis?
- The main symptom is sore and itchy eyelids. Some people say the eyelids feel as if they are 'burning'. Both eyes are affected.
- The eyelids may look inflamed or greasy.
- The eyes may become 'sticky' with discharge. In particular, the eyelids may stick together in the morning.
- Sometimes tiny flakes or scales appear on the eyelids which look
like small flakes of dandruff. Crusts may develop at the base of
eyelashes.
- One or more of the tiny glands of the eyelids (meibomian glands) may block and fill with an oily fluid.
Symptoms often 'come and go'. Typically, symptoms flare up from
time to time, but you may have long periods without any symptoms.
Three
other conditions are commonly associated with blepharitis and so you
may also have one or more of these conditions. They are:
- Dry
eye syndrome. This is especially if you have meibomian blepharitis when
the tiny glands in the eyelids do not function as well as normal.
- Seborrhoeic dermatitis - described above.
- Rosacea. Symptoms include facial flushing, and persistent central facial redness.
There are separate leaflets that discuss each of these conditions in detail.
What are the possible complications of blepharitis?
In
most cases, blepharitis is uncomfortable but not serious. Complications
are uncommon and most are not usually serious. They include:
- Meibomian
cyst (chalazion). This is a painless swelling most prominent on the
inside of the eyelid. It is due to a blocked meibomian gland. Although
it is painless, it may make the eyelid bulge and look a little
unsightly. It can be easily removed by a simple minor procedure.
Sometimes it can become infected and painful.
- 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.
- Contact lens wearers may find the lenses feel uncomfortable when they have a flare up of blepharitis symptoms.
- Changes to the eyelashes (which mainly occur in severe and long-standing cases). These include:
- Loss of eyelashes (madarosis).
- Misdirection of eyelashes towards the eye (trichiasis).
- Depigmentation of the eyelashes (poliosis).
- Eyelid ulceration and scarring (uncommon). This can cause
the eyelid to turn inwards against the eyeball (entropion) or outwards
(ectropion).
- Conjunctivitis (inflammation of the front of the eye).
- Conjunctival phlyctenules. These are small (1–3 mm), hard,
triangular, yellowish-white nodules (lumps) surrounded by prominent but
tiny blood vessels. If they develop they usually occur on the lower
part of the eye just below the cornea.
- Corneal inflammation (keratitis), ulceration, and scarring. This
complication is rare but serious as it can affect sight. See a doctor
urgently if you develop eye pain (more than the grittiness of dry eye)
or any loss of vision from the affected eye.
What is the treatment for blepharitis?
There
is no one-off cure as the inflammation tends to recur if you do not
keep up with treatment. However, with regular treatment, symptoms can
usually be eased and then kept to a minimum and prevented from flaring
up.
Regular eyelid hygiene
This is the most important part of treatment and prevention.
-
Bathe and gently press on the eyelids
with a flannel (facecloth) soaked in very warm water for 5-10 minutes.
This softens the skin and any crusts attached to the eyelids. If the
flannel cools, keep re-warming it in hot water.
-
Then massage the eyelids - gently roll your first finger on
the eyelids (like a rotary action). This helps to push out the oily
fluid from the tiny meibomian glands.
-
Then, clean the eyelids. This can be done by any of the
following ways. There is a lack of research studies to say which is the
best method, so use whatever you find most useful:
- The
traditional way is to use a cotton wool bud that has been dipped in
diluted baby shampoo. Just add a few drops of baby shampoo to a small
cup of warm water so that the ratio of water to shampoo is about 10:1.
Squeeze out excess liquid from the cotton bud to prevent drips getting
into your eyes which may irritate. In particular, try to clean off any
crusts at the base of the eyelids. After cleaning the eyelids with the
cotton wool bud, wash off the shampoo from the eyelids with a flannel
or cloth.
- Some people recommend using sodium bicarbonate (a teaspoonful in a
cup of cooled water that has recently been boiled). This is applied
using a clean cloth or cotton wool bud.
- Some people recommend using special eyelid scrubs that you can buy at pharmacies.
- Some people say that simply washing the eyelids with cooled water
that has recently been boiled (or preserved water for contact lens
wearers) is probably as effective as using water with added sodium
bicarbonate or baby shampoo.
You should do the above routine at least twice a day until
symptoms settle. When the symptoms have eased, keep doing this routine
once a day, every day, to prevent further flare-ups. If you are prone
to blepharitis it is best to think of this as part of your daily
routine - just like brushing your teeth. This is the best way to keep
symptoms away, or to a minimum.
Antibiotic treatments
Antibiotic eye
ointment or drops may be advised for a while if an eyelid becomes
infected. If you are prescribed ointment, place it on the edge of the
eyelid (not the eye) after cleaning the eyelid in the way described
above. You may need a course for up to a month or so until the
inflammation has gone completely.
Sometimes, antibiotic tablets are needed if antibiotic ointment or drops do not clear an infection.
Try not to rub your eyelids
Rubbing your eyelids may make inflammation worse.
Treating associated conditions
As mentioned above:
Seborrhoeic
dermatitis is common with people who have blepharitis. This is a skin
condition which is caused by an overgrowth of a yeast in the skin.
Seborrhoeic dermatitis causes bad dandruff and sometimes a rash,
commonly on the face and upper body. It can usually be treated easily
by using an anti-yeast shampoo. If you have seborrhoeic dermatitis,
treating it may improve the blepharitis too. See separate leaflet
called 'Seborrhoeic Dermatitis in Adults' for details.
People
with rosacea may also have blepharitis. Symptoms of rosacea can include
facial flushing, facial redness, facial spots, and thickening of the
skin. If you have rosacea, treatment of the rosacea may also help to
ease blepharitis. See separate leaflet called 'Rosacea' for details.
Many
people with dry eye syndrome also have blepharitis. Treating dry eyes
with artificial tears may also help ease symptoms of blepharitis. See
separate leaflet called 'Dry Eyes' for details.
Disclaimer: This article is for information only and should not
be used for the diagnosis or treatment of medical conditions. EMIS and
PiP have used all reasonable care in compiling the information but make
no warranty as to its accuracy. Consult a doctor or other health care
professional for diagnosis and treatment of medical conditions.
© EMIS and PiP 2008 Reviewed: 24 Jul 2008
