What is blepharitis?
Blepharitis is inflammation of the outer (anterior blepharitis) or inner (posterior blepharitis) parts of the eyelid margin (where the eyelashes are).
It is a very common condition in Australia, and can affect people of all ages, including children.
What causes blepharitis?
Blepharitis is due to a variety of causes, and there may be more than one cause in each person. These include:
- Bacterial (Staphylococcus) infection of the eyelids
- Scalp dandruff (seborrheic dermatitis)
- Acne rosacea
Blepharitis is a chronic ongoing condition. It is not known why the inflammation develops and persists in some patients, and not others. There is no cure for blepharitis, but there are treatments that can greatly minimise the symptoms and complications associated with this eyelid inflammation.
How do I know I have blepharitis?
Most people will experience one or more of the following symptoms from their blepharitis:
- “foreign body” sensation
- Frothy tears
- Sensitivity to light
- Crust on the eyelashes (especially in the morning)
- Red swollen eyelids
- Red eyes
Blepharitis is best diagnosed by your ophthalmologist, who can examine your eyelids in fine detail under the slit lamp microscope.
What can happen if I don’t treat blepharitis?
Symptoms will persist or worsen if blepharitis is not properly treated.
In some cases, complications may occur from the blepharitis which include:
- Stye (painful red lump on eyelid due to infection at the base of the eyelashes)
- Chalazion/Meibomian cyst (Painful or painless lump in the eyelid due to trapped fatty secretions)
- Dry eyes
- Misdirected eyelashes, that turn inward and rub on the surface of the eye
Blepharitis is not usually a threat to vision. However, having eyes that that are constantly uncomfortable, red or dry does impair overall visual function, and of course, quality of life.
How can I treat blepharitis?
Treatment aims to improve or eliminate all of the main symptoms of blepharitis, leading to a comfortable eye and eyelids, and reduce the risk of the development of complications.
As this is a chronic condition (like asthma or diabetes), there is no cure for it, but treatments can help control it. These treatments will need to be applied for the long-term, and include:
- Cleaning of the eyelids (eyelid scrubs)
- Warm or cold compresses
Occasionally, in cases of severe inflammation (redness and swelling), your ophthalmologist may also prescribe a short course of antibiotic eye ointment, anti-inflammatory eye ointment or oral antibiotics (doxycycline tablets) to help control the inflammation.
How to apply eyelid scrubs
You will need:
- Cotton balls or gauze
- Baby shampoo
- Large cup of warm (tap or boiled) water
Put 2-3 drops of the baby shampoo in the warm water. This should be a very dilute solution so that it does not sting the eyes excessively. Dip the cotton balls/gauze in the soapy solution. Close your eyes and wipe along the crease of the eyelids, where the upper eyelid meets the lower eyelid, several times. Only wipe the skin. Try not to wipe the INSIDE (wet) part of the eyelid. Then rinse thoroughly with water.
Eyelid scrubs should initially be applied twice per day (morning and night), then once per day long-term.
How to apply warm or cold compresses
These compresses are very good for relieving redness, swelling and itching of the eyelids.
Warm compresses can be made with a clean face towel soaked in warm (boiled) water, or a moist towel warmed in the microwave (be careful not to burn/overheat the towel).
Cool compresses can be made with a clean face towel soaked in ice-cold water, ice-cubes wrapped in a moist towel, or commercial gel-filled eye masks that are cooled in the fridge.
These compresses should be applied to CLOSED eyelids as often as possible (3-4 times per day) for about 5 mins at a time. Always test the temperature of the compress on the back of your hand before applying to your eyelids, to avoid burning yourself.
Should I stop wearing eye make-up?
Whilst your blepharitis is very active, then it is a good idea to temporarily stop wearing eye-liner/mascara/eye-shadow until your inflammation in under control. Always ensure that you thoroughly remove any eye make-up before bed, and apply your eyelid scrubs after make-up removal.
Can I wear my contact lenses?
Whilst you blepharitis is active, you should temporarily stop wearing your contact lenses until the inflammation is under control. Active inflammation and infection of your eyelids can reduce your tolerance for contact lens wear, as well as increase your risk of contact lens-related eye infections.
What if my blepharitis does not improve with treatment?
If you apply your treatment correctly and diligently, most people will achieve excellent control of their symptoms.
However, it is important to always consult your ophthalmologist if your symptoms do not improve despite good treatment. In rare cases, certain eyelid tumours (sebaceous carcinoma) can mimic the symptoms and signs of blepharitis. If your ophthalmologist suspects this, they will perform a small biopsy of the eyelid to rule this out.