Blepharitis – how to ease it

Blepharitis isn’t usually serious, but it can be uncomfortable – discover the simple ways to manage it.


What are the symptoms?

What causes it?

Self-help tips

When to see a doctor

How is blepharitis diagnosed?

What are the treatments?

Where to get support

If you often have red, swollen eyelids, crusty areas around your lashes, and eye irritation, you could have blepharitis. It’s a common condition that causes inflammation around the edges of your eyelids. The good news is you can usually manage it yourself with some simple measures. 

Blepharitis is inflammation of the rims (edges) of the eyelids, causing redness, irritation, and swelling – usually affecting both eyes. It tends to be a long-term condition that can cause repeated episodes.

Blepharitis is common, and although it isn’t usually serious, it can be uncomfortable. It can interfere with your ability to wear contact lenses and/or makeup, and you may feel self-conscious when your eyes are red and swollen. 

However, there are steps you can take to manage it and help prevent recurrences.

## What are the symptoms?

Blepharitis symptoms tend to come and go, and may be worse in the morning. They can include:

- sore, swollen eyelids
- red eyes and eyelids
- itchy eyes and eyelids
- crusty flakes around the base of your eyelashes
- eyelids sticking together when you first wake up
- a gritty, burning feeling in your eyes 
- sensitivity to light.

Sometimes, blepharitis can lead to other issues, including:

- __dry eyes__ – oily secretions, flakes and other debris from your eyelids can collect in the tear film that keeps your eyes moist, causing dryness, irritation, and sometimes excess tearing
- __problems with your eyelashes__ – blepharitis can cause them to fall out, grow in abnormal directions, or lose color
- __problems with eyelid skin__ – over time, repeated bouts of blepharitis may cause scarring on the eyelids, or the edges of the eyelids may turn in or out
- __stye__ – an infection near the eyelash edge causing a red, sore lump
- __chalazion__ – a blockage in 1 of the oil glands at the eyelid rim can cause inflammation of the gland, leading to a firm, usually painless lump
- __recurrent conjunctivitis (pink eye)__
- __damage to the cornea as a result of ongoing irritation__ – lack of tears can also raise the risk of infection. 


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## What causes it?

There isn’t a clear, direct cause, but it’s thought blepharitis may develop as a result of 1 or more of the following:

- dandruff in the scalp or eyebrows (known as seborrheic dermatitis) 
- blockages in the eyelid glands that make the oil component of tear film
- an infection 
- [rosacea](https://www.livehealthily.com/health-library/conditions/rosacea) (a skin condition that causes redness or flushing on the face)
- allergies (including allergic eye reactions)
- eyelash mites or lice
- dry eyes.

You can’t catch blepharitis or spread it to other people.


## Self-help tips

For most people, self-care is enough to control blepharitis. The key way to manage and reduce symptoms is through eyelid hygiene. 

For this, be sure to clean your eyelids twice a day, dropping to once a day as your symptoms get better. You need to practice eyelid hygiene even when you’re symptom-free. The aim is to encourage healthy tears by softening the oils in the eyelid glands, clearing any blockage within the glands, and removing flakes and bacteria. 

Here’s how to do it:

- wash your hands
- remove any contact lenses
- hold a warm compress firmly over your closed eyes for a few minutes to soften and loosen crusty deposits. You could use a microwavable eye bag, a clean flannel, or cotton wool soaked in warm water
- immediately massage each eyelid gently, 1 at a time
- clean the rims of your eyelids using a cotton bud dampened with warm water and a few drops of diluted baby shampoo, or a special eyelid wipe you can buy from pharmacies. Clean around the lashes to remove any flakes or crusts and sweep away excess oils and bacteria.

Other self-care measures include:

- __not using contact lenses__ and eye makeup, especially mascara and eyeliner, while you have symptoms
- __using over-the-counter artificial tears__ to lubricate dry eyes
- __managing dandruff__, if you have it, with a dandruff shampoo – your healthcare professional can recommend one.

You can also talk to your doctor about trying omega-3 fatty acids, found in foods such as oily fish and flaxseed and in supplements. More evidence is needed, but this might help if your blepharitis is linked with rosacea.


## When to see a doctor

See a healthcare professional if blepharitis symptoms don’t improve after a few weeks of eyelid hygiene. They can also help you manage conditions that may be contributing.

If symptoms don’t go away with treatment, you’ve also lost eyelashes or only 1 eye is affected, always see a healthcare professional to rule out other conditions.

If you have severe blepharitis or other symptoms, you may be referred to a specialist. 

## How is blepharitis diagnosed?

Your doctor will ask about your medical history. They will also examine your eyes, lids, and lashes with a bright light or special magnifying tool.

They may take a swab, for example of the oil or crust on your eyelids, to check for bacteria, fungi, or signs of an allergy. 


## What are the treatments?

You may be prescribed treatments to manage blepharitis, and any underlying conditions, such as rosacea, that may be connected. 

These include:

- __topical antibiotics to treat any infection and ease symptoms__ – either as eye drops, creams, or ointments you apply to your lids
- __oral antibiotics__ – to help with inflammation, if your condition is linked with rosacea
- __steroid eye drops__ – or ointments to manage inflammation
- __other topical treatments__ – that target the immune system
- __treatment with a device__ – that uses heat and massage to unblock oil glands. This is carried out under medical supervision.

You may need a combination of treatments. And it’s important you carry on [practising eyelid hygiene daily](https://www.livehealthily.com/health-library/conditions/blepharitis#selfcare-tips), along with any treatments from your healthcare professional.


## Where to get support

For more information, try these organizations:

- [Moorfields Eye Hospital](https://www.moorfields.nhs.uk/eye-conditions/blepharitis)
- [American Academy of Ophthalmology](https://www.aao.org/)


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References

Charlotte Haigh

Jo Wheatley

Dr Maria Reza

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