Blepharitis is a common eye condition causing red, swollen eyelids and irritation. Learn about its signs, causes, diagnosis, and management options.
Have you ever experienced red, swollen eyelids accompanied by a gritty sensation and irritation? If so, you might be suffering from blepharitis, a chronic ocular inflammation that affects the eyelid margin.
Blepharitis, commonly referred to as granulated eyelids, is a prevalent condition that can affect individuals of all ages. According to a survey conducted, blepharitis is common among American adults. It is one of the more frequently seen conditions in clinical practice, and younger people tend to report more frequent symptoms than older individuals.1
In this article, we will explore the signs, symptoms, causes, diagnosis, and some frequently asked questions about blepharitis to help you better understand this common eye condition.
Signs and symptoms of blepharitis
If you suspect you may have blepharitis, it's essential to recognize the common signs and symptoms associated with this condition. Typically, these symptoms are more pronounced in the morning. They include: 2
- Swollen and greasy eyelids: The edges of your eyelids may appear red or dark in color and become swollen and scaly. You may also notice an excess of oil on your eyelids.
- Red, irritated eyes: Your eyes may feel itchy or burned, and they might appear red and inflamed.
- Crusting and stickiness: Blepharitis can cause the formation of crusts on your eyelashes and at the corners of your eyelids. These crusts may make your eyelids stick together.
- Skin flakes: Flakes of skin may collect around your eyes and eyelids, causing irritation.
- Dryness or excessive tearing: You might experience dry eyes, such as a gritty or sandy sensation. Conversely, your eyes may also water excessively.
- Excessive blinking: Some individuals with blepharitis find themselves blinking more frequently than usual.
In addition to these primary symptoms, other possible signs of blepharitis include light sensitivity, blurred vision, loss of eyelashes, and trichiasis, where eyelashes grow toward the eyes instead of away from them.
Causes of blepharitis
Understanding the causes of blepharitis is crucial for effective management and treatment. Several factors can contribute to the development of this condition, including:2
- Meibomian gland dysfunction: Issues with the meibomian glands, which produce the oils found in tears, can lead to blepharitis. These glands may become clogged or malfunction, affecting the quality of the tears and the overall health of the eyelids.
- Dry eyes: Dry eye syndrome, characterized by insufficient tear production or poor tear quality, can predispose individuals to blepharitis.
- Skin conditions: Certain skin conditions, such as seborrheic dermatitis (dandruff of the scalp and eyebrows) and rosacea (facial redness), can cause irritation of the eyelid margin (the edge of the eyelid) and contribute to the development of blepharitis.
- Infection: In some cases, blepharitis may arise from an infection, either bacterial or viral, affecting the eyelids.
- Allergies: Allergic reactions to eye medications, contact lens solutions, eye makeup, or other environmental allergens can trigger blepharitis symptoms.
- Eyelash infestations: Infestation by eyelash mites or lice can lead to chronic inflammation of the eyelids.
Identifying blepharitis
To determine if you have blepharitis, your doctor will evaluate the symptoms that you are experiencing and examine your eyelids using a specialized microscope. In some cases, additional tests may be conducted to gather more information, such as culturing samples from the eyelids for potential infection, imaging of the meibomian glands, or examining eyelashes for mites. These evaluations aid in the diagnosis of blepharitis and assist in creating an appropriate treatment plan.2
Managing blepharitis
The primary goal in managing blepharitis is to reduce its symptoms and signs, minimize structural damage, and prevent any loss of visual function. There are several self-care measures and professional treatments that can help achieve these goals.
Personal hygiene practices
- Warm compresses: Applying warm compresses to the eyelids can provide soothing relief. Simply take a clean washcloth, wet it with warm water, wring out the excess water, and place it over your closed eyelids. This helps soften crusts and makes it easier to remove oily debris. Alternatively, you can use commercially available microwavable heat masks, which retain heat for longer durations and may be more effective.
- Lid scrubs: Over-the-counter lid scrubs are available in various forms, such as sprays or foams. These products, often containing hypochlorous acid, help reduce dandruff on your lashes and decrease bacterial growth on your eyelid skin.
- Avoid eye makeup: To minimize irritation, it is advisable to steer clear of eye makeup until the inflammation is under control.
- Take omega-3: Research suggests that omega-3 fatty acids found in fish or flaxseed oil can improve the functioning of the glands in your eyes. Examples of fish highest in omega-3 include mackerel, salmon, and sardines.
Medications and therapies
If self-care measures alone are not sufficient, your healthcare provider may recommend prescription treatments tailored to your specific needs. These can include:
- Antibiotics: Antibiotics applied directly to the eyelid have shown to be effective in relieving symptoms and resolving bacterial infections associated with blepharitis. These antibiotics are available in the form of eye drops, creams, or ointments. In cases where topical antibiotics are not effective, your doctor may prescribe oral antibiotics to target the underlying infection.
- Inflammation control: Steroid-based eye drops or ointments may be prescribed to control inflammation, particularly for individuals who do not respond well to other therapies. In some cases, your doctor may prescribe a combination of antibiotic and anti-inflammatory medications.
- Immunosuppression: Topical cyclosporine, such as Restasis, has shown promise in relieving certain signs and symptoms of blepharitis by modulating the immune system.
It is important to note that if blepharitis is caused by an underlying condition such as seborrheic dermatitis or rosacea, treating the primary disease can help manage the associated blepharitis.
Common Questions about Blepharitis
Is blepharitis contagious?
Blepharitis is a chronic inflammation of the eyelids; it is not contagious. Although it can be uncomfortable and unsightly, it typically does not cause permanent damage to your eyesight. Rest assured that you cannot transmit blepharitis to others.
What is the difference between blepharitis vs. stye?
A stye, also known as a hordeolum, is a bump that develops along the eyelash line when the oil glands in that area become clogged and infected. While styes can be a complication of blepharitis, they differ from blepharitis in a few key ways. Blepharitis affects the entire eyelid, whereas a stye appears as a single pimple-like bump on one eye. Styes are typically acute and last for a few days or a week, whereas blepharitis is often a chronic condition.
What is the difference between blepharitis vs. conjunctivitis or pink eye?
Blepharitis is an irritation and inflammation of the eyelids, while conjunctivitis, commonly known as pink eye, can have various causes, including bacterial or viral infections, allergic reactions, or irritants. Unlike blepharitis, pink eye can be contagious if it results from an infection. Both conditions can cause discomfort in the eyes, but they are distinct in their causes and symptoms.
What is the difference between blepharitis vs. chalazion?
A chalazion can sometimes develop as a complication of blepharitis. It manifests as a small, painless swelling or bump on the eyelid. A chalazion occurs when one of the small oil glands at the eyelid margin becomes blocked. In some cases, the gland can become infected with bacteria, resulting in a red and swollen eyelid. Unlike a stye, a chalazion is typically more prominent on the inside of the eyelid.
What is the difference between blepharitis vs. meibomitis?
Meibomitis is closely related to blepharitis and refers to the inflammation of the meibomian glands. These glands produce a thicker, milky oil that can become blocked at the openings along the eyelid margins. The symptoms of meibomitis are similar to those of dry eyes, with red, tender, and irritated eyelids. People with meibomitis may also experience matted eyelashes and increased lash loss. Visual disturbances can occur due to the instability of the tear film, leading to intermittent blurriness.
Does coffee cause blepharitis?
There is no direct link between coffee consumption and blepharitis. While some researchers have hypothesized that caffeine might worsen dry eyes and potentially contribute to blepharitis, limited evidence supports this claim. So, if you enjoy your morning cup of coffee and don’t consume them excessively, you need not worry about it causing blepharitis.
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- Lemp MA, Nichols KK. Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. Ocul Surf. 2009;7(2 Suppl):S1-S14. [Link]
- Amescua, Guillermo et al. “Blepharitis Preferred Practice Pattern®.” Ophthalmology vol. 126,1 (2019): P56-P93. [Link]
- Magno, Morten Schjerven et al. “The Relationship Between Caffeine Intake and Dry Eye Disease.” Cornea vol. 42,2 (2023): 186-193. [Link]
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