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.

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

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.

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.

Other causes

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

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.

Most people will experience repeated episodes of blepharitis and then have long periods of time where they do not have any symptoms.

Symptoms tend to be worse in the morning and include:

  • itchy, sore red eyelids,
  • your eyelids stick together and you may have problems opening your eyes when you wake up,
  • your eyelashes become crusty,
  • a burning, gritty sensation in the eyes,
  • increased sensitivity to light (photophobia),
  • abnormal eyelash growth, and
  • loss of eyelashes.

Both eyes are affected by blepharitis.

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.

Side effects of oral antibiotics are rare because the dose used is relatively low, and the condition will usually resolve quickly. Side effects include:

  • nausea,
  • vomiting,
  • stomach aches,
  • diarrhoea, and
  • (in women) yeast infections, such as thrush.

Side effects should pass quickly as your body gets used to the antibiotics.

Some of the oral antibiotics used in the treatment of blepharitis have been known to make people more sensitive to the effects of the sun. Therefore you should avoid prolonged exposure to sunlight, and the use of sunlamps or sun beds, while taking them.