Blepharitis is when the rims of the eyelids become inflamed. This can make your eyes red, irritated and itchy. Dandruff-like crusts can appear on your eyelashes.

Blepharitis can be caused by bacterial infection or can be a complication of skin conditions such as seborrhoeic dermatitis (a skin condition that can cause itchy rashes on the skin and scalp). When seborrhoeic dermatitis affects the scalp, it's called dandruff. Another associated skin condition is rosacea, which causes the face to appear red and blotchy.

Blepharitis is a chronic condition, meaning that once it develops you'll probably have repeated episodes. There is no cure. However, there are a range of treatments that can control the symptoms. The most important one is to establish a daily eye-cleaning routine. More severe cases of blepharitis may require the use of antibiotics.

It is estimated that blepharitis is responsible for 5% of all eye problems that are reported to GPs. It is more common in older adults, but can develop at any age.

Complications of blepharitis include dry eye syndrome (where the eyes do not produce enough tears, or dry out too quickly), styes (a pus-filled swelling in or on the eyelid) and conjunctivitis (inflammation of the eye). The condition is not normally serious. Serious complications such as sight loss are rare, especially when you follow the recommended advice.

Causes of blepharitis 

There are two types of blepharitis:

Anterior blepharitis - this is when the inflammation affects the outside front edge of your eyelids, where your eyelashes are connected, and

posterior blepharitis - this is when the inflammation affects the inside front edge of your eyelids, where they come into contact with your eye.

Sometimes, people will experience both types of the condition as the causes of blepharitis are often connected.

Anterior blepharitis or Seborrhoeic blepharitis

Many cases of anterior blepharitis are caused by a bacterial infection. Blepharitis that is caused by bacteria is often referred to as staphylococcal blepharitis.

Anterior blepharitis can also occur as a complication of seborrhoeic dermatitis. Seborrhoeic dermatitis is known to cause oily skin, so it is thought that this excess oil can irritate the eyelids and provide a breeding ground for bacteria.

Blepharitis that is caused by seborrhoeic dermatitis is often referred to as seborrhoeic blepharitis.

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.

Posterior blepharitis

Posterior blepharitis is caused when something affects the glands that are found at the rim of your eyelids. These glands are responsible for producing an oily substance that makes up the top layer of your tears. This oily substance is needed to keep your tears in place and help protect your eyes.

Skin conditions such as seborrhoeic dermatitis or rosacea are known to affect how these glands work.

In the case of seborrhoeic dermatitis, the glands produce too much oil, so as in the case of anterior blepharitis; the excess oil is thought to offer a breeding ground to bacteria.

In the case of rosacea, not enough oil is produced. However, this is still a problem, as your eyes are not being properly protected by your tears, so they also become vulnerable to infection.

Around 50% of people with rosacea will experience associated eye symptoms such as redness and irritation. Rosacea that affects the eyes is known as ocular rosacea. Though ocular rosacea is unlikely to develop in people already taking oral antibiotics for rosacea.

Left untreated, ocular rosacea can lead to iritis (inflammation of the iris) or keratitis (inflammation of the cornea).

Blepharitis that is caused by problems with the Meibomian gland is often referred to as Meibomian blepharitis.

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 sore, but not too bad. You may then rub them - which makes the inflammation worse. This in turn can lead to your eyelids becoming more sore. You may then keep rubbing them further, which leads to more inflammation, and so on.

Dry eye syndrome

Dry eye syndrome is a common complication of blepharitis. Dry eye syndrome (also known as keratoconjunctivitis sicca) is a condition where your eyes do not make enough tears, or the tears evaporate too quickly. This can lead to the eyes drying out and becoming inflamed.

Dry eye syndrome can occur because the conditions that are associated with blepharitis, seborrhoeic dermatitis and rosacea, can also affect the quality of your tears.The symptoms include itchiness, or scratchiness, around your eyes, a gritty feeling in the eyes, and blurred vision.

The symptoms of dry eye syndrome can normally be successfully controlled by using eye drops that contain tear substitutes which is a liquid that is designed to mimic the properties of tears. These eye drops are available from a pharmacist over-the-counter (OTC) without a prescription.

Conjunctivitis

Conjunctivitis is an inflammation of the eyes. It occurs when bacteria in the eyelid then infect the eyes. The condition is not normally serious and should not affect your vision.

Most cases of conjunctivitis will pass in one to two weeks without the need for treatment. Antibiotic eye-drops may be prescribed if symptoms persist, or you have repeated infections. However, there is little evidence to suggest that antibiotic eye-drops resolve the condition any quicker than waiting for the condition to clear up on its own.

Meibomian Cyst

A Meibomian cyst is swelling that occurs in the eyelids. They can happen when one of your Meibomian tear glands gets inflamed as a result of blepharitis.

Cysts are normally painless, unless they get infected, in which case antibiotics may be needed. Applying a hot compress to the cyst should help bring the cyst down, although they often disappear by themselves. If a cyst persists, it can be removed during a simple surgical procedure that is carried out under local anaesthetic.

Styes

A stye is a painful swelling that develops on the outside of the eyelid. They are caused by a bacterial infection of an eyelash follicle (located at the base of your eyelash).

Mild cases can be treated by applying a hot compress to the area. More serious cases can be treated with antibiotic creams and tablets.

Other causes

Less commonly blepharitis can develop as a result of an allergic reaction, or an infestation of lice on the eyelashes.

Treatment

Most cases of blepharitis can be diagnosed by the GP asking you about your symptoms, making an examination of your eyes and checking for any associated medical condition such as seborrhoeic dermatitis or rosacea.

If your symptoms are particularly severe, or you have experienced any loss of vision, you may be referred to an ophthalmologist (an expert in the treatment of eye conditions).

They will run further tests to make sure that your symptoms are not being caused by another condition, such as a more serious type of eye infection.

Eye hygiene

Developing a regular routine of eye hygiene is essential in the treatment of blepharitis. It is important that you clean your eyelids every day, whether or not you are experiencing any symptoms. You should consider it part of your daily routine, like showering or brushing your teeth. Effective eye hygiene will reduce both the severity and frequency of symptoms.

You should apply a warm compress (cloths or cotton wool warmed with hot water) to your closed eyelids for five to ten minutes. Gently rub the compress over your closed eyelids for two to three minutes, and then repeat. This will help loosen any crusting.

Then gently clean your eyelids with a cotton bud. Using warm water with a small amount of baby shampoo, or sodium bicarbonate (a teaspoon dissolved in a cup of water) is recommended. You should always use a mirror when cleaning your eyelids as this will prevent any possible damage to your eyes.

A number of commercial products are also available for eye cleaning. Your GP or pharmacist will be able to advise you.

At the beginning of treatment, or if your symptoms are particularly severe, you may need to carry out this routine several times a day. Once symptoms are under control, it should only be necessary to clean your eyes once a day.

You should avoid wearing eye make-up, especially eyeliner. If you feel that you absolutely have to use eye make-up and eyeliner, make sure that it washes off easily.

Antibiotic creams

If your blepharitis does not respond to regular cleaning, a short-course (normally four to six weeks) of antibiotic ointments or creams (topical antibiotic) may be recommended.

The cream should be rubbed onto your eyelids using clean fingers or a cotton bud, after you have finished cleaning your eyes and/or before you go to sleep. Once your condition begins to respond to treatment, you should only need to apply the cream once a day.

You should avoid wearing contact lenses when using the cream. If their use is essential, you may be given additional eye drops.

You may experience some mild stinging or burning as you apply the cream, but this should pass quickly.

You should not drive if you find that the cream makes your vision blurred.

Antibiotic tablets

In some circumstances, you may be given antibiotic tablets (oral antibiotics) at the beginning of your treatment. For example, when it is clear that a skin condition, such as rosacea, is aggravating your blepharitis. Oral antibiotic may also be recommended if you do not respond to other forms of treatment.

Most people respond well after 2-4 weeks, although you will probably be required to take them for at least six weeks. It is important to finish the course, even if your symptoms get better.

Serious complications of blepharitis are rare. The most common problem people face is they are unable to wear contact lenses. It may be necessary for you to use an alternative aid, such as glasses, until your symptoms are under control.

These articles are sourced from various avenues, all contents within Pure and Gentle Skincare website is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any health care professional. Pure and Gentle Skincare is not responsible or liable for any diagnosis made by a user based on the content of Pure and Gentle Skincare website or advisors. Always consult your own GP if you're in any way concerned about your health as he or she will be able to advise in greater details.