Introduction  

Blepharitis is an eye disorder characterized by irritation, itching, reddening, inflammation, scaling and crusting of the eyelid. The edges of the eyelids become swollen, red and inflamed.  

Blepharitis is one of the most common eye conditions and affects people of all ages. But, it is more common among people with dandruff, oily skin or dry eyes. 

Blepharitis is classified as a chronic external eye disorder because it is often a long term eye condition. It can be challenging to manage and tends to recur which means patients may need ongoing treatment. 

Severe cases of the eye disease can cause irreversible damage such as the alterations of the eyelid margin. It can also create a dry eye or aggravate it. However, it rarely leads to any permanent eye damage or loss of vision.

Blepharitis is not contagious.

Also Known As

Inflammation of the eyelids

Sub-Types

  • Anterior blepharitis

It relates  to the outside edge of the eyelid, the point where eyelashes attach. It occurs when the eyelids are infected.

  • Posterior blepharitis

It occurs in the inner side of the eyelid which touches the eyeball. It happens when the eyelid gland is blocked and infected.
 

Causes and Risk Factors

There are many causes of blepharitis.
Often, anterior blepharitis is caused by scalp dandruff and bacteria known as Staphylococcus. 

Posterior blepharitis is linked to oil glands problems in the inner layer of the eyelid.  This type of blepharitis is also associated with two skin disorders: 

  • Acne rosacea 
  • Seborrheic dermatitis or scalp dandruff

The risk factors for blepharitis include:

  • Age where people above 50 are at a higher risk
  • Clogged eyelid oil glands 
  • Malfunctioning eyelid oil glands 
  • A bacterial infection
  • Eyelash lice or mites
  • Allergies including reactions to contact lenses and medication
  • Old and outdated eye makeup
  • Rosacea - A skin disorder characterised by facial redness
  • Seborrheic dermatitis - Dandruff of the eyebrows and scalp
  • Seborrheic dermatitis - Dandruff of the eyebrows and scalp
     

Signs & Symptoms

Symptoms of the disorder include:

  • A grain or burning sensation
  • Red eye
  • Excessive tearing or watery eyes 
  • Dry eye 
  • Frothy tears 
  • Itching 
  • Blurred vision 
  • Red and swollen eyelids 
  • Crusting of the eyelashes
  • Sensitivity to light 
  • Misdirected eyelashes

Diagnosis

The eye professional can diagnose blepharitis through a comprehensive eye exam. A professional can identify the type of blepharitis according to the appearance of the eyelid margins. 
The eye test which emphasises on the eyelids and the front surface of the eyeball may include:

  • External examination of the eye
  • Evaluation of the eyelid margins
  • Assessment of the tears to check for any abnormalities
  • Patient history - Helps to assess symptoms the patient is experiencing and any health problems that may be contributing to the eye condition
     

Treatment 

Treatment is aimed at keeping the eyelids clean and free of crusts.

Medical Treatment

The eye doctor may prescribe: 

  • Antibiotics to fight the infection
  • Anti-inflammatory drugs such as ointments or steroid eye drops
  • Medication for the immune system
  • Treatment for underlying health problems

It is important to note that blepharitis is rarely cured. It is often a chronic condition and treatment seeks to relieve the symptoms.

Surgical Treatment

The doctor may also use the following procedures:

  • Intense pulse light therapy 
  • Electrochemical lid margin debridement 
  • Thermal pulsation treatment 

Home Care

In most cases, blepharitis can be managed through home treatment. 

  • Good hygiene helps to control blepharitis. Some examples include: 
  • Cleaning the eyes daily 
  • Washing the scalp and face; applying warm compresses to the eyelids to loosen the crust and lightly scrubbing the eyelids. 
  • Lubricating the eyes
  • Artificial tears may help to relieve dry eyes
  • Controlling mites and dandruff
  • Anti-dandruff shampoo may help to reduce signs and symptoms of blepharitis. Using tea tree shampoo daily may help to handle mites.

Prognosis/Long-term outlook

Blepharitis is a chronic eye disorder with periods of remission and exacerbation.
Complications from the disorder include:

  • Injury to the cornea
  • Eyelash problems
  • Eyelid skin problems
  • Excess tearing or dry eye
  • Difficulty wearing contact lenses.

Patients often need to manage blepharitis in the long term.

Prevention/Follow Up

Frequent washing of the eyelids helps to subdue the symptoms of blepharitis and to prevent it. One should wash each eyelid for half a minute, at least twice a day with baby shampoo and ample water.

Using an over the counter lid scrub twice a day may also be an effective deterrent.