Blepharitis

What is blepharitis?

Blepharitis is a common condition that causes inflammation of your eyelids, usually where your eyelashes grow. It happens when the tiny oil glands along your eyelid margin become blocked or irritated, and while it's not usually serious, it's a long-term condition that tends to flare up and settle down again.

Symptoms of blepharitis

Symptoms often come and go, and can affect your eyelids, the surface of your eyes, and occasionally your vision.

• Red, sore, greasy or swollen eyelids
• Itchy eyes, or a gritty, burning or stinging feeling
• Flakes or crusts around the base of your eyelashes
• Eyelids sticking together, usually when you wake up
• Watery eyes, or eyes that feel unusually dry
• Increased sensitivity to light, and blinking more than usual
• Blurred vision that tends to improve after you blink
• In longstanding cases, loss of eyelashes, or eyelashes that grow in the wrong direction

Causes of blepharitis and who's at risk

There's no single, direct cause of blepharitis. Instead, it tends to result from a combination of the following:

• A build-up of bacteria that normally live harmlessly on your skin
• The oil glands in your eyelids not producing enough oil, or producing oil that's too thick to flow properly
• A skin condition such as seborrhoeic dermatitis (a dandruff-like condition), rosacea, or eczema
• An overgrowth of microscopic mites, called Demodex, that can live in the base of your eyelashes

It's very common, particularly in people who have oily skin, dandruff, eczema or rosacea. Blepharitis cannot be passed on to other people.

Are there different types of blepharitis?

Blepharitis is generally grouped into two main types, and it's possible to have a mixture of both:

• Anterior blepharitis: affects the front of your eyelid, around the roots of your eyelashes. It's usually linked to a build-up of skin bacteria or dandruff-like flaking, and can cause styes or eyelash loss. Around half of people with this type also have some degree of dry eye
• Posterior blepharitis: affects the meibomian glands, further back along your eyelid margin. The oil these glands produce becomes thick and struggles to flow, which irritates the glands and can lead to a chalazion (a fluid-filled lump on the eyelid). This type is often linked to rosacea

How is blepharitis diagnosed?

Blepharitis is usually recognised by the appearance of your eyelids and eyelashes, so a formal test isn't normally needed. If you see an optometrist or ophthalmologist, they can confirm the diagnosis, check for related conditions such as dry eye or rosacea, and prescribe treatment if you need it.

How is blepharitis treated?

There's no single cure for blepharitis, but daily eyelid care controls the symptoms for most people. It's worth persevering, even once your eyes feel better, since symptoms tend to return if you stop.

Daily eyelid hygiene

This is the most important treatment, and is usually needed once or twice a day:

1. Warm your eyelids for around 5 minutes with a clean flannel soaked in comfortably warm water, or a heated eye mask, to soften the oil inside the glands
2. With clean hands, gently massage your closed eyelids using a rolling motion of your fingers, working the oil towards your lash line, rather than rubbing across the skin
3. Wipe away the released oil and any crusts using a clean, damp cotton pad or flannel, or a small amount of diluted baby shampoo, wiping along your lash line

Avoid wearing contact lenses or eye makeup while you have symptoms, and always remove makeup thoroughly.

Lubricant eye drops

Many people with blepharitis also have dry eyes, so lubricating eye drops used regularly throughout the day can help with grittiness, watering and light sensitivity, and a lubricating ointment at bedtime can help overnight. These come in different thicknesses to suit mild, moderate or more severe dryness, and preservative-free versions are available if standard drops irritate your eyes.

Omega-3 and lifestyle measures

There's some evidence that omega-3 fatty acid supplements, such as flaxseed or fish oil, can help ease symptoms over the long term. Taking regular breaks from screens, blinking often, and keeping your hair, scalp and eyebrows clean with an antibacterial shampoo if you have dandruff can also help.

Medical treatment for more severe cases

If eyelid hygiene alone isn't enough, a GP may prescribe an antibiotic or steroid eye ointment for a short course. For longstanding cases that don't settle, oral antibiotics such as doxycycline (usually for one to three months) or azithromycin (usually for one to three weeks) are sometimes used to improve the quality of the oil your glands produce. If you're prescribed doxycycline, be aware it shouldn't be taken alongside the blood-thinning medicine warfarin without medical advice.

A small number of private clinics also offer thermal pulsation treatments or light therapy for blepharitis, for those who want to explore options beyond standard NHS treatment.

When should I see a doctor?

See a GP, optometrist or ophthalmologist if your symptoms don't improve, or get worse, despite a few weeks of consistent eyelid hygiene, or if you keep getting frequent or painful styes or chalazia.

Get urgent advice, for example from NHS 111 or an urgent GP appointment, if you have eye pain, changes to your vision such as blurring or vision loss, or eyes that become very red, as these can be signs of a more serious problem.