Blepharitis
Blepharitis is inflammation of the eyelid margin — the narrow strip where the lashes grow and the ducts of the oil glands open.
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Medicines commonly prescribed for Blepharitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: EYEDROP, 5 mg/mlActive substance: moxifloxacinManufacturer: Novartis Farmaceutica S.A.Prescription requiredDosage form: OPHTHALMIC OINTMENT, 10 mgActive substance: chloramphenicolManufacturer: Omnivision GmbhPrescription requiredDosage form: EYEDROP, 5 mg/mlActive substance: moxifloxacinManufacturer: Omnivision GmbhPrescription required
Blepharitis is inflammation of the eyelid margin — the narrow strip where the lashes grow and the ducts of the oil glands open. The lids turn red and puffy, the eyes itch and sting, the lashes stick together overnight and scales collect around their roots. It is not contagious and almost never threatens sight, but it is a long-term condition: it flares and settles in waves over months and years. The good news is that how it behaves depends mostly on daily care rather than on medicines.
What happens at the lid margin
Two rows of structures run along the edge of the eyelid. At the front are the lash roots with their small oil glands; behind them, closer to the eye, are the openings of the meibomian glands, which release an oily fluid. That oil forms the top layer of the tear film and stops it evaporating.
Inflammation can settle in either zone, and the picture depends on where. When the front edge suffers, scales and crusts sit on the lashes and the rim of the lid reddens. When the meibomian glands stop working properly, their openings clog, the secretion thickens and the tear film breaks up sooner than it should — and then the main complaint is not itching but dryness, soreness and a gritty feeling. Most often both patterns are present together.
Hence the key point about treatment: drops that ease the inflammation for a day change nothing inside the glands. What does change them is regular warming and cleaning of the lid margin.
How it feels
- itching and burning along the lid edge, sometimes worst first thing in the morning;
- a gritty feeling, as though a speck is stuck and will not wash out;
- a red, slightly thickened rim of the lid;
- scales, crusts or whitish collars at the base of the lashes;
- lashes glued together after sleep;
- dryness, eyes tiring quickly when reading or working on a screen, poor tolerance of contact lenses;
- from time to time, styes and firm painless lumps within the lid;
- over the years, lashes may thin out or start growing in the wrong direction.
Symptoms are usually present in both eyes, though one may bother you more. They almost disappear and then return, often alongside tiredness, dry air, long spells at a screen or a flare of a skin condition.
Why the lid margin becomes inflamed
Blepharitis has no single cause; several usually come together.
- Bacteria that live on the skin. Everyone has them and normally they do no harm, but where skin oil is plentiful they multiply near the lash roots and keep the inflammation going.
- Meibomian gland dysfunction — the commonest basis of long-standing blepharitis: the secretion becomes as thick as paste and cannot get out.
- Seborrhoeic dermatitis. Where there is dandruff and flaking on the brows and around the nose, the lid margin is nearly always involved.
- Rosacea. Persistent redness of the cheeks and nose with visible small vessels often goes with a stubborn blepharitis that ordinary hygiene will not shift.
- Demodex mites. They live in hair follicles; too many of them produce the characteristic collars at the lash base and relentless itching.
- Dry eye — both a consequence of blepharitis and something that makes it worse: the circle closes.
- Allergic contact dermatitis to cosmetics, make-up removers or eye drops.
Blepharitis does not pass from person to person: you cannot give it to the family through a towel or a pillow.
Daily care is the mainstay
Lid hygiene has three steps and takes a few minutes.
- Warmth. A warm, damp compress on the closed lids for five to ten minutes. The heat should be comfortable, not hot: it softens the thickened secretion inside the glands.
- Massage. Immediately afterwards, gently massage the lid with a fingertip, moving from the fold towards the lash edge, about half a minute per eye. This pushes the softened secretion out.
- Cleaning. Wipe along the rim at the lash roots with a pharmacy lid-hygiene wipe, a cotton pad with a ready-made cleanser, or heavily diluted baby shampoo. The eyeball itself is not rubbed; the work is done only along the lid edge.
For the first few weeks the routine is done twice a day, after which once is usually enough. The commonest mistake is stopping as soon as things improve: symptoms return within a couple of weeks. It helps to think of this not as a course of treatment but as brushing your teeth — a daily habit.
Small things matter too: touching the eyes less, humidifying the air, taking breaks from the screen, and using tear substitutes for dryness — preferably preservative-free if drops are needed often. If there is dandruff or rosacea, these need treating as well, otherwise the lids will keep flaring.
When care alone is not enough
See a doctor if a month of careful hygiene has changed nothing, if flares follow one another without a break, or if the eye itself has become noticeably red and sore.
A doctor may prescribe a short course of antibiotic ointment or drops where the front lid margin is markedly inflamed with crusts and pus. In severe meibomian gland dysfunction and in rosacea, oral antibiotics are used at a low dose over a long period: they are chosen less for suppressing bacteria than for their effect on the make-up of the glandular secretion. There are limits here — the tetracycline group is not given in pregnancy, while breastfeeding or to children, and another class is chosen instead. Where Demodex is abundant, specific lid-margin products are used. Anti-inflammatory steroid drops are sometimes needed, but only on an eye specialist's instruction and only briefly: used without supervision they raise the pressure inside the eye.
A firm painless lump within the lid (a chalazion) is first treated with the same compresses and massage; if it has not resolved after several weeks, it is removed or injected.
What should not be blamed on blepharitis
Blepharitis affects the lid, not the eye itself. If any of the following appear, the diagnosis needs rethinking, and quickly.
- pain in the eye rather than in the lid; marked sensitivity to light;
- reduced or blurred vision;
- vivid redness of the eyeball, especially around the iris;
- rapidly increasing lid swelling with fever, pain on moving the eye or the eye pushed forward — this may be orbital cellulitis, which is an emergency;
- a thickening of the lid that does not go away, distorts the rim and comes with loss of lashes in that spot;
- a chalazion that keeps returning to exactly the same place on the same lid.
The last two deserve particular attention. A rare malignant tumour of the oil glands of the eyelid can spend years disguised as chronic one-sided blepharitis, or as an "ordinary" chalazion that is removed and grows back. The warning signs are one-sidedness, loss of lashes over the affected area and failure to respond to treatment. In that situation the eye specialist takes a piece of tissue for examination — not over-caution, but the only way not to miss a rare but dangerous possibility.
Lenses, make-up and flares
During a flare it is better to take contact lenses out and wear glasses: an inflamed lid margin worsens lens tolerance and raises the risk of a corneal infection. Go back to lenses a few days after the redness settles, starting with a fresh pair and fresh solution.
Eyeliner and mascara are also best put aside while a flare lasts — they block the gland openings in exactly the place where the ducts need to be freed. In quiet periods make-up is acceptable, but not along the inner lid margin; remove it the same evening and replace an opened mascara every few months. Lash extensions and tattooing between the lashes almost always make matters worse in anyone prone to blepharitis.
Online consultation
In an online consultation the doctor goes through how long the flares have been happening and what pattern they follow, helps tell blepharitis apart from conditions that need an urgent face-to-face examination, works through the lid hygiene technique step by step — where the reason for failure usually lies — and advises what to raise with an eye specialist and with a dermatologist.
This material is for information only and does not replace medical advice.
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