This is Inflammation of the eyelids, with redness, irritation, and scaly skin affecting the upper eyelids and the lid margins. Blepharitis may cause burning and discomfort in the eyes and flakes or crusts on the lashes. The condition is common, tends to recur, and is sometimes associated with dandruff of the scalp or eczema. Severe blepharitis may lead to corneal ulcers, though this is rare. In many cases, treatment of associated dandruff with an antifungal shampoo will result in improvement of the blepharitis.
Blepharitis is often caused by staphylococcal bacteria (usually staph. aureus). It can be treated by careful lid hygiene. Eye specialists often advise their patients to gently wash their eyelids with Johnson's baby shampoo diluted with water. This cleans the eyelids, removes the dead skin flakes and bacteria. It is a no tears formula and does not irritate the eyes.
It is important to clean your eyelids daily. This is if you have symptoms or not. Good eye hygiene is able relieve your symptoms and also prevents them from coming back. The treatment plan is to treat and prevent blepharitis:
- Apply a warm compress (a cloth 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, then repeat. This will help loosen any crusting.
- Use a cloth or cotton bud with warm water and a small amount of cleaning solution (see below), and gently rub the edge of your eyelids to clean them.
- Carry out these steps twice a day at first, then once a day when your symptoms have improved.
- Do not wear eye make-up, particularly eyeliner and mascara, as this can make your symptoms worse. If you have to wear eyeliner, make sure that it washes off easily.
To clean your eyelids, use one of the following with warm water:
- a small amount of baby shampoo (1 part baby shampoo to 10 parts warm water)
- sodium bicarbonate (1 teaspoon dissolved in a cup of water which has been boiled and then cooled)
- a lid-cleaning solution (there are a number of commercial products available)
Your family doctor, GP or pharmacist can tell you which cleaning solutions are suitable for you. However, you may need to try more than one product to find one that suits you.
If you have blepharitis that does not respond to regular cleaning, you may be prescribed a course of antibiotic ointments or creams (topical antibiotics). You will need to use these for four to six weeks. You may be prescribed:
- chloramphenicol eye ointment (Chloromycetin)
- fusidic acid eye ointment (Fucithalmic)
The ointment or drops should be rubbed gently onto the edge of your eyelids, up to three times a day, using either clean fingers or a cotton bud. Once your condition begins to respond to the treatment, you will only need to apply the antibiotic once a day.
- Avoid wearing contact lenses when using topical antibiotics. Let your GP know if wearing contact lenses is essential, you may be given additional eye drops. If you are using more than one type of eye drop, leave at least five minutes before applying the second type of drops to your eyes.
- You may experience some mild stinging or burning when applying antibiotic ointment or drops to your eyes, but this should pass quickly. Do not drive if the ointment blurs your vision.
- In some circumstances (severe and unresponsive cases of blepharitis), you may be prescribed an oral antibiotic (to take by mouth) at the start of your treatment.A commonly prescribed antibiotic is a tetracycline such as oxytetracycline or minocycline (Minocin). For example, oral antibiotics may be prescribed when it is clear that a skin condition, such as rosacea, is aggravating your blepharitis. Oral antibiotics may also be recommended if your blepharitis does not respond to other treatment.
- Most people respond well after two to four weeks of treatment, although you will probably be required to take them for at least six weeks. It is important for you to finish the course of antibiotics, even if your symptoms get better.
Some oral antibiotics used to treat blepharitis have been known to make people more sensitive to the effects of the sun. Therefore, avoid prolonged exposure to sunlight and using sun lamps or sun beds while you are taking them. Side effects of oral antibiotics are rare because the dose is relatively low. However, they may include vomiting, diarrhoea and yeast infections (candida or thrush) in women.
Treating other conditions
- seborrhoeic dermatitis (a skin condition that causes your skin to become inflamed or flaky)
- dandruff (dry, flaky skin on your scalp)
Blepharitis in more detail - technical article
Anterior blepharitis is a common chronic bilateral inflammation of the lid margins. There are two main types: staphylococcal and seborrheic. Staphylococcal blepharitis may be due to infection with Staphylococcus aureus, in which case it is often ulcerative, or Staphylococcus epidermidis or coagulase-negative staphylococci. Seborrheic blepharitis (nonulcerative) is usually associated with the presence of Pityrosporum ovale, although this organism has not been shown to be causative. Often, both types are present (mixed infection). Seborrhea of the scalp, brows, and ears is frequently associated with seborrheic blepharitis.
The chief symptoms are irritation, burning, and itching of the lid margins. The eyes are "red-rimmed." Many scales or "granulations" can be seen clinging to the lashes of both the upper and lower lids. In the staphylococcal type, the scales are dry, the lids are red, tiny ulcerated areas are found along the lid margins, and the lashes tend to fall out. In the seborrheic type, the scales are greasy, ulceration does not occur, and the lid margins are less red. In the more common mixed type, both dry and greasy scales are present and the lid margins are red and may be ulcerated. Staphylococcus aureus and P. ovale can be seen together or singly in stained material scraped from the lid margins.
Staphylococcal blepharitis may be complicated by hordeola, chalazia, epithelial keratitis of the lower third of the cornea, and marginal corneal infiltrates. Both forms of anterior blepharitis predispose to recurrent conjunctivitis.
The scalp, eyebrows, and lid margins must be kept clean, particularly in the seborrheic type of blepharitis, by means of soap and water shampoo. Scales must be removed from the lid margins daily with a damp cotton applicator and baby shampoo. Staphylococcal blepharitis is treated with antistaphylococcal antibiotic or sulfonamide eye ointment applied on a cotton applicator once daily to the lid margins.
The seborrhoeic and staphylococcal types usually become mixed and may run a chronic course over a period of months or years if not treated adequately; associated staphylococcal conjunctivitis or keratitis usually disappears promptly following local antistaphylococcal medication.
Posterior blepharitis is inflammation of the eyelids secondary to dysfunction of the meibomian glands. Like anterior blepharitis, it is a bilateral, chronic condition. Anterior and posterior blepharitis may coexist. Seborrheic dermatitis is commonly associated with meibomian gland dysfunction. Colonization or frank infection with strains of staphylococci is frequently associated with meibomian gland disease and may represent one reason for the disturbance of meibomian gland function. Bacterial lipases may cause inflammation of the meibomian glands and conjunctiva and disruption of the tear film.
Posterior blepharitis is manifested by a broad spectrum of symptoms involving the lids, tears, conjunctiva, and cornea. Meibomian gland changes include inflammation of the meibomian orifices (meibomianitis), plugging of the orifices with inspissated secretions, dilatation of the meibomian glands in the tarsal plates, and production of abnormal soft, cheesy secretion upon pressure over the glands. Hordeola and chalazia may also occur. The lid margin shows hyperemia and telangiectasia. It also becomes rounded and rolled inward as a result of scarring of the tarsal conjunctiva, causing an abnormal relationship between the precorneal tear film and the meibomian gland orifices. The tears may be frothy or abnormally greasy. Hypersensitivity to staphylococci may produce epithelial keratitis. The cornea may also develop peripheral vascularization and thinning, particularly inferiorly, sometimes with frank marginal infiltrates. The gross changes of posterior blepharitis are identical to the ocular findings in acne rosacea.
Treatment of posterior blepharitis is determined by the associated conjunctival and corneal changes. Frank inflammation of these structures calls for active treatment, including long-term low-dose systemic antibiotic therapy—usually with doxycycline (100 mg twice daily) or erythromycin (250 mg three times daily), but guided by results of bacterial cultures from the lid margins—and (preferably short-term) treatment with weak topical steroids, eg, prednisolone, 0.125% twice daily. Topical therapy with antibiotics or tear substitutes is usually unnecessary and may lead to further disruption of the tear film or toxic reactions to their preservatives.
Periodic meibomian gland expression may be helpful, particularly in patients with mild disease that does not warrant long-term therapy with oral antibiotics or topical steroids. Hordeola and chalazia should be treated appropriately.