Blepharitis

What is blepharitis?

Blepharitis is an inflammation of the eyelids. It usually affects the edges (margins) of the eyelids. It is not usually serious, but may become an uncomfortable, irritating problem. Blepharitis is typically chronic (persistent). Both eyes are usually affected.

• The main symptom is sore eyelids. The eyelids may look inflamed or greasy.
• Sometimes tiny flakes or scales appear on the eyelids which look like small flakes of dandruff. Crusts may develop at the base of eyelashes.
• Sometimes the eyelids also become infected. If they do the eyes may become 'sticky' with discharge. In particular, the eyelids may stick together in the morning.
• One or more of the tiny glands of the eyelids (meibomian glands) may block and fill with an oily fluid. The glands may also become infected which can cause a stye, or damage to eyelashes.
• Many people with blepharitis also make less tears than normal. This may lead to dry eyes which can cause the eyes to feel gritty and sore.

What causes blepharitis?

The exact cause is not known. It tends to 'flare-up' and then ease off in severity. If you have blepharitis, you are likely to always have a tendency to have it. Sometimes a 'vicious cycle' may play a part. For example, your eyelids may become slightly inflamed and itchy. You may then rub them - which makes the inflammation worse. This in turn can lead to your eyelids becoming sore. You may then keep rubbing them further, which leads to more inflammation, and so on.

What is the treatment for blepharitis?

There is no one-off cure as the inflammation tends to recur. However, symptoms can usually be eased with regular treatment.

Regular eyelid hygiene
This is the most important part of treatment and prevention.

• Bathe and gently press on the eyelids with a flannel (facecloth) soaked in very warm water for 5-10 minutes. This softens the skin and any crusts attached to the eyelids. If the flannel cools, keep re-warming it in hot water.
• Then massage the eyelids - gently roll your first finger on the eyelids (like a rotary action). This helps to push out any of the mucus-like fluid from the tiny eyelid glands.
• Then, clean the eyelids. This can be done by any of the following ways. There is a lack of research studies to say which is the best method, so use whatever you find most useful:
  • The traditional way is to use a cotton wool bud that has been dipped in baby shampoo diluted with warm water. Some experts say you should use a 50:50 mixture of baby shampoo to warm water. Other experts say you should just add a few drops of baby shampoo to a small cup of water. So, use whatever dilution you find most useful. Squeeze out excess liquid from the cotton bud to prevent drips getting into your eyes which may irritate. In particular, try to clean off any crusts at the base of the eyelids. After cleaning the eyelids with the cotton wool bud, wash off the shampoo from the eyelids with a flannel or cloth.
  • Some people recommend using sodium bicarbonate (a teaspoonful in a cup of cooled water that has recently been boiled). This is applied using a clean cloth or cotton wool bud.
  • Some people recommend using special eyelid scrubs that you can buy at pharmacies.
  • Some people say that simply washing the eyelids with cooled water that has recently been boiled (or preserved water for contact lens wearers) is probably as effective as using water with added sodium bicarbonate or baby shampoo.

You should do the above routine at least twice a day until symptoms settle. When the symptoms have gone, keep doing this routine once a day, every day, to prevent further flare-ups.

Antibiotic treatments
Antibiotic eye ointment or drops may be advised for a while if an eyelid becomes infected. If you are prescribed ointment, place it on the edge of the eyelid (not the eye) after cleaning the eyelid in the way described above. You may need a course for up to a month or so until the inflammation has gone completely.

Rarely, antibiotic tablets are needed if antibiotic ointment or drops do not clear an infection.

Artificial tear eye drops
These will help if you develop dry eyes. See separate leaflet called 'Dry Eyes' for details.

Treating associated conditions
A condition called seborrhoeic dermatitis is associated with blepharitis. This is a skin condition which is caused by an overgrowth of a yeast in the skin. Seborrhoeic dermatitis causes bad dandruff and sometimes a rash, commonly on the face and upper body. It can usually be treated easily by using an anti-yeast shampoo. If you have seborrhoeic dermatitis, treating it may improve the blepharitis too. See separate leaflet called 'Seborrhoeic Dermatitis in Adults' for details.

Other skin conditions of the face such as eczema and rosacea may also make blepharitis worse. If you have these other conditions, if possible, treatment may also help to ease blepharitis.

Try not to rub your eyelids
Rubbing your eyelids may make inflammation worse.

© EMIS and PIP 2005   Updated: May 2006   PRODIGY Validated