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Blepharitis ˌblef-ə-ˈrīt-əs

By James Garrity, MD, Whitney and Betty MacMillan Professor of Ophthalmology, Mayo Clinic College of Medicine

Blepharitis is inflammation of the edges of the eyelids, possibly with thickening scales, crusts, shallow ulcers, or redness and swelling at the edges of the eyelids.

  • The inflammation is caused by certain infections, allergic reactions, and some skin conditions.

  • The eyelids become irritated, red, and swollen and may burn and itch.

  • Usually the diagnosis is based on symptoms and the appearance of the eyelids.

  • Any underlying disorders are treated, and sometimes antibiotic ointments or drops, antiviral pills, corticosteroid ointment, artificial tears, or a combination is given.

Causes of Blepharitis

Disorders that may cause blepharitis include bacterial (typically staphylococcal) infection of the eyelids or the ducts of the deeper glands that open at the edges of the eyelids, certain viral infections (usually herpes simplex), and allergic reactions (to pollens or sometimes to eye drops).

Skin conditions such as seborrheic dermatitis, rosacea, and atopic dermatitis (eczema) affect the face including the eyelids, leading to inflammation and blepharitis.

Another cause is inflamed, blocked oil glands at the edge of the eyelids (called meibomian gland dysfunction), which can be caused by rosacea.

Eye drops can trigger allergic reactions that cause blepharitis (called contact sensitivity allergic blepharitis).

Sometimes the inflammation has no known cause.

Symptoms of Blepharitis

Blepharitis may cause the feeling that something is in the eye. The eyes and eyelids may itch and burn, and the edges of the eyelids may become red. The eyes may become watery and sensitive to bright light.

In some types of blepharitis, such as those caused by bacterial infections, the eyelids may swell, and some of the eyelashes may turn white or even fall out. This type of blepharitis is usually acute. Sometimes, small abscesses containing pus (pustules) develop in the sacs at the base of the eyelashes and eventually form shallow ulcers (ulcerative blepharitis). A crust may form and stick tenaciously to the edges of the eyelids. When the crust is removed, the surface may bleed. During sleep, secretions dry and make the eyelids stick together.

In some types of blepharitis, such as those caused by blocked oil (meibomian) glands, the glands become plugged up with hard, waxy deposits. This type of blepharitis can be chronic. Patients often have seborrheic dermatitis or rosacea and develop styes or chalazia (eyelid cysts).

Some patients with blepharitis develop dry eyes.

Most types of blepharitis tends to recur and stubbornly resist treatment. Blepharitis is inconvenient and unattractive but usually does not damage the cornea or result in loss of vision. Occasionally, ulcerative blepharitis can result in a loss of the eyelashes, scarring of the eyelid margins, and, rarely, even inflammation affecting the cornea.

Diagnosis of Blepharitis

  • Symptoms and a doctor's examination

Diagnosis of blepharitis is usually based on the symptoms and the appearance of the eyelids. A doctor may use a slit lamp to examine the eyelids more closely. Occasionally, a sample of material is taken from the edges of the eyelids and is cultured to identify the type of bacteria causing the infection and determine how sensitive it is to commonly used antibiotics.

Treatment of Blepharitis

  • Supportive measures (for example, compresses, eyelid cleansing)

  • Treatment of the cause

Certain treatments can help relieve symptoms such as irritation. Artificial tears used during the day and lubricating ointments applied at night may help. Symptoms can also be relieved with wet compresses, typically cool for allergic or contact sensitivity blepharitis and warm for all other causes of blepharitis. Occasionally, if these measures are ineffective, a corticosteroid ointment is used.

The problem causing the blepharitis is treated when possible. For example, an eye drop that seems to be causing allergic contact sensitivity blepharitis can be stopped.

To treat ulcerative blepharitis caused by bacteria, a doctor may prescribe an antibiotic ointment or drops, such as bacitracin plus polymyxin B, gentamicin, erythromycin, or sulfacetamide, or an antibiotic taken by mouth (such as doxycycline).

Viral blepharitis is treated with antiviral pills (such as valacyclovir) that are effective against herpes simplex, which is the usual cause.

For blepharitis caused by seborrheic dermatitis, treatment usually includes keeping the eyelids clean by gently scrubbing the edges of the eyelids twice a day with a wash cloth or cotton swab dipped in a dilute solution of baby shampoo (2 or 3 drops in ½ cup of warm water). When seborrheic dermatitis is the cause, the face and scalp must be treated as well. Sometimes, punctal plugs (inserts that block the punctum or tear duct and thus decrease tear drainage) help.

For meibomian gland dysfunction, warm compresses may help the oil to flow from the meibomian oil glands and relieve inflammation, easing the itching and burning. Eyelid massage may help release the oil from the meibomian glands that help coat the eye. Rosacea that causes meibomian gland dysfunction should also be treated.

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