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Blepharitis Content Supplied by NHS Choices
Introduction

Blepharitis is a common condition where the edges of the eyelids (eyelid margins) become red and swollen (inflamed).

Blepharitis can develop at any age, and symptoms can include:

  • itchy, sore and red eyelids that stick together
  • crusty or greasy eyelashes
  • a burning, gritty sensation in your eyes
  • increased sensitivity to light (photophobia)
  • swollen eyelid margins
  • finding contact lenses uncomfortable to wear
  • abnormal eyelash growth or loss of eyelashes in severe cases

In most cases both eyes are affected, but one eye can be more affected than the other. The symptoms tend to be worse in the morning.

When to get medical advice

See your high-street optician (optometrist) if you have persistent symptoms of blepharitis that aren't being controlled by simple eyelid hygiene measures.

They can examine you to check if the problem is caused by an underlying condition, or may refer you to an eye specialist.

Contact your optometrist or GP immediately if you have any severe symptoms. If this isn't possible, visit your nearest accident and emergency (A&E) department.

How blepharitis is treated

Blepharitis is usually a long-term condition. Most people experience repeated episodes, separated by periods without symptoms.

It can't usually be cured, but a daily eyelid-cleaning routine can help control the symptoms and prevent permanent scarring of the eyelid margins.

There are three main steps to eyelid hygiene that should be performed once or twice a day:

  • using a warm compress - to make the oil produced by the glands around your eyes more runny
  • gently massaging your eyelids - to push the oils out of the glands
  • cleaning your eyelids - to wipe away any excess oil and remove any crusts, bacteria, dust or grime that might have built up

More severe cases may require antibiotics that are either applied to the eye or eyelid directly, or taken as tablets.

Read more about treating blepharitis.

What causes blepharitis

There are three main types of blepharitis:

  • anterior blepharitis - where the inflammation affects the skin around the base of your eyelashes
  • posterior blepharitis - where the inflammation affects your Meibomian glands, found along the eyelid margins behind the base of the eyelashes
  • mixed blepharitis - a combination of both anterior and posterior blepharitis

Anterior blepharitis can be caused by either:

  • a reaction to Staphylococcus bacteria - these usually live harmlessly on the skin of many people, but for unknown reasons they can cause the eyelids to become inflamed
  • seborrhoeic dermatitis - a skin condition that causes skin to become oily or flaky and sometimes irritate the eyelids, causing the Meibomian glands to block

Posterior blepharitis is caused by a problem with the Meibomian glands, where the glands get blocked by either debris, skin flakes or inflammation.

Sometimes blockages in the Meibomian glands are associated with a skin condition called rosacea. If too much oily substance is being produced, this may be caused by seborrhoeic dermatitis.

Mixed blepharitis, which is the most common, is caused by a combination of both anterior and posterior blepharitis.

Blepharitis isn't contagious.

Complications

Blepharitis isn't usually serious, although it can lead to a number of further problems.

For example, many people with blepharitis also develop dry eye syndrome, where the eyes don't produce enough tears or dry out too quickly. This can cause your eyes to feel dry, gritty and sore.

Serious, sight-threatening problems are rare, particularly if any complications that develop are identified and treated quickly.

Read about the complications of blepharitis.

Treating blepharitis

Blepharitis can't usually be cured, but the symptoms can be controlled with good eyelid hygiene.

Blepharitis is a long-term (chronic) condition. Most people experience repeated episodes, separated by periods with no symptoms.

Eyelid hygiene

It's important to clean your eyelids every day if you have blepharitis, even if you're using medication or don't currently have any symptoms.

Good eyelid hygiene can help ease your symptoms and prevent it happening again.

Follow the steps below to keep your eyelids clean.

Warm compresses

  • boil water and leave it to cool to a warm temperature
  • soak a clean flannel or eye pad in the water and gently place this over the eyes for around 10 minutes
  • make sure the flannel doesn't get cold by reheating it in the warm water

Some people find that using a special microwaveable eyebag is useful. If you use one of these products, make sure you clean the bag before and after use.

Eye lid massage

  • gently massage your closed eyes by rolling your little finger in a circular motion
  • take a cotton wool bud and, with your eyes shut, gently roll it downwards on the upper eyelid towards the lashes and edges of the eyelids - this helps to push the melted oil out of the glands, but you won't be able to see the tiny droplets
  • repeat this process along the whole width of the upper and lower eyelids

This process may slightly irritate your eyes at first, a bit like getting soap in your eyes. However, this is normal and should get better with time.

Lid margin hygiene

Various eyelid-cleaning solutions and eyelid wipes are available commercially, or you can try making one at home.

For a home-made solution, fill a bowl with one pint of boiled water and allow it to cool to a warm temperature. Add a teaspoon of bicarbonate of soda.

Once you've made a cleaning solution:

  • soak some clean cotton wool in the solution and remove crustiness from around the eyelids, paying special attention to the eyelashes
  • repeat this process if necessary using a clean piece of cotton wool
  • dip a clean cotton bud into the solution and gently clean the edges of the eyelids by wiping the cotton bud along the bases and lengths of the lashes

Your GP, pharmacist or optometrist can advise you about suitable cleaning solutions, although you may need to try more than one product to find one that suits you.

It's important to continue lid margin hygiene two or three times a week, even if you don't have symptoms. This helps to prevent permanent scarring of the eyelid margins.

Antibiotic drops and ointments

If you have blepharitis that doesn't respond to regular cleaning, you may be prescribed a course of antibiotic ointments, creams or eye drops (topical antibiotics). You'll usually need to use these for around four to six weeks.

Ointments and creams should be rubbed gently on to the edge of your eyelids, usually several times a day at first, using either clean fingers or a cotton bud.

Once your condition begins to improve, you may only need to do this once a day, usually at night after cleaning your eyelids using the method outlined above.

Cautions

You should avoid wearing contact lenses when using antibiotic eye drops, as the drops may build up behind the lenses and irritate your eye.

If you're using more than one type of eye drop at the same time of day, leave at least five minutes before applying the second type of drops.

Let your GP or optometrist know if you have continual irritation as they may recommend lubricant treatments.

You may experience some mild stinging or burning when applying antibiotic ointment or drops, but this should pass quickly. Don't drive if the ointment blurs your vision.

Oral antibiotics

Low doses of antibiotics can be used as anti-inflammatory agents for a minimum of three to four months, or sometimes much longer.

You may be prescribed antibiotics to take by mouth once or twice a day if your blepharitis doesn't respond to other treatments.

Oral antibiotics may also be recommended at the start of your treatment if it's thought rosacea is aggravating your symptoms.

Most people respond well within the first few weeks of treatment, although you may need to take them for up to three months. It's important for you to finish the course of antibiotics, even if your symptoms get better.

Cautions

Some oral antibiotics used to treat blepharitis have been known to make people more sensitive to the effects of the sun. While you're taking them, you should avoid prolonged exposure to sunlight and using sun lamps or sunbeds.

Oral antibiotics can also sometimes affect unborn and developing babies, so they're not normally used to treat women who are pregnant or breastfeeding. Certain types of antibiotics are avoided in children under 12.

Side effects of oral antibiotics are rare because the dose is very low. However, you should be aware of stomach upsets, vomiting or diarrhoea.

Oily tear eye drops

Oily tear drops are particularly useful if your blepharitis is causing quick evaporation of tears.

Eye drops that replace the oily part of the tear film and reduce evaporation from the surface of the eye are increasingly being used. These preparations include synthetic guar gums or liposomal sprays.

Liposomal sprays are over-the-counter medications that aren't available on prescription. They're sprayed on to the edges of your eyelids when your eyes are closed. When you open your eyes, the solution spreads across the surface of the eye, creating a new oily film.

Diet

There's some evidence to suggest a diet high in omega-3 fats can help improve blepharitis.

The best sources of omega-3s are oily fish, such as:

  • mackerel
  • salmon
  • sardines
  • herring
  • fresh or frozen tuna - not canned, as the canning process sometimes removes the beneficial oils

Aim to eat at least two portions of fish a week, one of which should be oily fish.

You can also get omega-3s from various nuts and seeds, vegetable oils, soya and soya products, and green leafy vegetables.

Omega 7 or sea buckthorn oil has also been found to be helpful.

Treating other conditions

If you have an underlying medical condition that's causing blepharitis, your GP will prescribe treatment for it or refer you to an appropriate specialist to ensure the condition is treated effectively.

Depending on the suspected cause of your condition and any other symptoms you have, you may also need additional treatment.

For example, if you have seborrhoeic dermatitis or dandruff, you may need to use an anti-dandruff shampoo on your scalp and eyebrows.

If you have dry eye syndrome, which frequently occurs alongside blepharitis, you may need separate treatment for this, such as "artificial tear" eye drops.

Complications of blepharitis

Blepharitis can cause many different problems, although serious complications are rare.

Some of the complications associated with blepharitis can potentially affect your vision, although your eyesight shouldn't be permanently damaged if these problems are identified and treated quickly.

Some of the main complications of blepharitis are described below.

Dry eye syndrome

Dry eye syndrome is a common complication of blepharitis. It occurs when your eyes don't make enough tears or your tears evaporate too quickly. This can lead to your eyes drying out and becoming inflamed, which can cause them to feel dry, gritty and sore.

Dry eye syndrome can be caused by the same skin conditions that can cause blepharitis, as these can also affect the quality of your tears. These include:

  • seborrhoeic dermatitis - a condition that causes your skin to become oily or flaky
  • rosacea - a condition that mainly affects the face

Speak to your high-street optometrist at an opticians if you have constantly dry eyes. They may recommend using eye drops containing "artificial tears", often available from pharmacists without a prescription.

Conjunctivitis

Conjunctivitis is inflammation of the conjunctiva. This is the transparent membrane that covers the white part of the eyeball and the inner surfaces of the eyelids.

Conjunctivitis can occur when bacteria in the eyelid infect the eyes. The condition isn't usually serious and shouldn't affect your vision.

Most cases of conjunctivitis are mild and pass in one to two weeks without the need for treatment. However, you should contact your GP or an optometrist if you think you have conjunctivitis.

If you wear contact lenses, you should remove these and not wear them again until the conjunctivitis is better.

Antibiotic eye drops may be prescribed if your symptoms continue or you have repeated infections.

Meibomian cysts

A Meibomian cyst is when there's swelling on the inside of your eyelids. A cyst can develop if one of your Meibomian glands, which produce an oily substance that forms part of your tears, becomes inflamed as a result of blepharitis.

The cysts are normally painless, unless they get infected. In these cases you should see your GP or an optometrist, as antibiotics may be needed. Applying a hot compress to the cyst should help reduce the swelling, although cysts often disappear by themselves.

If a cyst doesn't disappear, it can be removed with a simple surgical procedure carried out under local anaesthetic (painkilling medication).

Read more about eyelid problems.

Styes

A stye is a painful swelling that produces pus and develops on the outside of your eyelid at the base of the eyelash (eyelash follicle). Styes are caused by a bacterial infection.

A mild stye can be treated by applying a warm compress - a cloth warmed with hot water - to the area.

See your GP or an optometrist if you have a very painful stye that isn't getting better. If this happens, the stye may need to be drained using a small needle.

Read more about treating styes.

Damage to the cornea

In severe cases of blepharitis or cases that don't respond very well to treatment, the redness and swelling (inflammation) can damage the surface of the cornea, the transparent layer at the front of the eye. This is called keratitis.

Sometimes the cornea can become vulnerable to ulceration and infection, which is a sight-threatening condition. This is frequently associated with severe pain.

It's essential that you get immediate medical advice if you notice symptoms of keratitis, including:

  • sudden eye pain
  • sensitivity to light
  • a worsening in vision

Contact your GP or a local emergency eye care service immediately if you experience any of these symptoms. If you can't, visit your nearest accident and emergency (A&E) department.

 
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