Overview

Blepharitis is a common inflammatory condition affecting the eyelids, particularly at the base of the eyelashes. It can involve either the front (anterior blepharitis) or back (posterior blepharitis) portion of the eyelid, and sometimes both. Blepharitis is a chronic condition that often causes discomfort, redness, crusting, and irritation around the eyes. While it is rarely serious, it can be persistent and frustrating, requiring long-term management. Proper hygiene and treatment can effectively control symptoms and prevent complications such as eye infections or eyelash problems.

Causes

Blepharitis can result from several factors, and it is often associated with other skin or eye conditions. Common causes include:

• Bacterial infection: Staphylococcus bacteria are frequently implicated in anterior blepharitis.
• Meibomian gland dysfunction (MGD): Blocked or abnormal oil glands in the eyelids cause posterior blepharitis.
• Seborrheic dermatitis: An oily skin condition that can contribute to dandruff-like flaking on the eyelids.
• Rosacea: A skin disorder that can affect the eyes, leading to inflammation of the eyelids.
• Allergic reactions: Allergies to cosmetics, contact lenses, or environmental factors may trigger blepharitis.
• Mite infestation (Demodex): Tiny mites that live in hair follicles can cause irritation and inflammation.
• Poor eyelid hygiene: Accumulation of debris and oil around the lashes can lead to bacterial overgrowth and inflammation.

Symptoms

The symptoms of blepharitis can vary in severity and may affect one or both eyes. Common signs include:

• Redness and swelling of the eyelids
• Itchy, burning, or stinging sensation in the eyes
• Crusty debris or dandruff-like flakes at the base of the eyelashes
• Watery or dry eyes (can alternate between both)
• Sensitivity to light (photophobia)
• Blurred vision, which usually improves with blinking
• Gritty or foreign body sensation in the eyes
• Frequent blinking or eye rubbing
• Loss of eyelashes or abnormal eyelash growth in chronic cases

Diagnosis

Blepharitis is typically diagnosed through a clinical examination by an eye care professional:

• Medical history: Discussion of symptoms, duration, and any contributing skin or eye conditions.
• Physical examination: Careful inspection of the eyelids, eyelashes, and the eye surface using magnification tools.
• Slit-lamp examination: A specialized microscope helps examine eyelid margins, meibomian glands, and the eye’s surface for inflammation or debris.
• Swab or culture: In recurrent or severe cases, swabs of the eyelid margins may be taken to identify bacterial or mite involvement.

Treatment

Treatment for blepharitis focuses on controlling symptoms and reducing inflammation through consistent eyelid hygiene and additional therapies:

• Eyelid hygiene: Daily cleansing of the eyelid margins with warm compresses and gentle scrubbing using diluted baby shampoo or eyelid-specific cleansers.
• Warm compresses: Applying a warm compress helps loosen crusts, unclog glands, and relieve discomfort.
• Antibiotic treatment:
  • Topical antibiotics: Eye drops or ointments like erythromycin for bacterial infections.
  • Oral antibiotics: Doxycycline may be prescribed for chronic or posterior blepharitis, especially if associated with rosacea.
• Anti-inflammatory medications: Short-term use of steroid eye drops may be recommended to reduce inflammation.
• Artificial tears: Lubricating eye drops relieve dryness and irritation.
• Treatment of underlying conditions: Managing rosacea, seborrheic dermatitis, or allergies can improve blepharitis symptoms.
• In-office treatments: Procedures like meibomian gland expression or intense pulsed light (IPL) therapy may be used in refractory cases.

Prognosis

Blepharitis is generally a chronic condition with a tendency to recur, but with proper care, most individuals can achieve good symptom control:

• Chronic management: Regular eyelid hygiene is key to preventing flare-ups.
• Symptom relief: Many patients experience significant improvement in comfort and reduction in eye irritation with consistent treatment.
• Complications: If left untreated, blepharitis can lead to complications like styes, chalazia, conjunctivitis, or corneal problems.
• Long-term outlook: While it is rarely curable, blepharitis can be effectively managed, allowing most individuals to maintain healthy, comfortable eyes.

Ongoing communication with an eye care provider ensures optimal management and adjustment of treatments as needed.