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Blepharitis - Types, Causes, Symptoms, Diagnosis, and Treatment

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Blepharitis refers to a common eye disorder and is characterized by the inflammation of the eyelids. Read the article to know more.

Medically reviewed by

Dr. Asha Juliet Barboza

Published At March 16, 2023
Reviewed AtMarch 16, 2023

What Is Blepharitis?

Blepharitis is an inflammation of the eyelids in which the eyelids become red, irritated, and itchy, with dandruff-like scales forming on the eyelashes. It is often caused by bacteria or a skin condition such as scalp dandruff or rosacea. It affects the edges of the eyelids; hence it is also known as lid margin disease. Blepharitis most often affects both eyes. It may rarely affect one eye. Once blepharitis develops, a secondary infection is possible. Though unpleasant, most cases are not contagious and will not result in blindness.

What Are the Types of Blepharitis?

There are two types of blepharitis:

  • Anterior blepharitis occurs on the outside of the eye, near the lashes. It can be caused by dandruff on the brows and allergic reactions in the eyes.

  • Posterior blepharitis affects the inner edge of the eyelids closest to the eye. This type of inflammation is usually caused by a malfunctioning oil gland behind the eyelash follicles.

What Are the Causes of Blepharitis?

Although the precise cause of blepharitis cannot always be determined, various factors may increase the risk of blepharitis. Bacteria or inflammatory conditions are thought to be among the main reasons.

  • Anterior Blepharitis

    • Rosacea Acne: Rosacea causes inflammation of the skin on the face, including the eyelids.

    • Allergies: Contact lens solution, eye drops, or makeup allergies can cause irritation.

    • Dandruff (Seborrheic Dermatitis): Dandruff flaking can irritate and inflame the eyelids.

    • Dry Eye: Bacterial resistance can be altered by dry tear ducts, leading to infection.

    • Eyelash Lice Or Mites (Demodicosis): Demodex mites or lice can clog eyelash follicles and glands.

  • Posterior Blepharitis

    • Meibomian Gland Dysfunction (MGD): Oil-producing gland openings in the eyelids become clogged, resulting in dry eye, which can lead to inflammation and infection. This is the most common type and maybe the least preventable. Skin conditions such as rosacea or dandruff can also cause posterior blepharitis.

What Are the Symptoms of Blepharitis?

Blepharitis can cause itchy eyelids that are red, swollen, and scaly. The eyelid surface becomes irritated, and crusts form as the scales become coarser, which may cause the lids to stick together. One might wake up with a crust on their eyelashes and eyelid edges that feels heavy. Instead of being clear or white, the eye discharge could be yellow or green. If the crust gets into the eye, one may experience a something in the eye sensation, or the eye may feel gritty.

Other signs and symptoms may include:

  • Burning sensation in the eyelid.

  • Blinking excessively.

  • Blurred vision.

  • Eyelash and eyelid corner crusting

  • Dry eye.

  • Eyelids stuck together.

  • Excessive tearing.

  • Skin flakes around the eyes and eyelids.

  • Oily eyelids.

  • Itching.

  • Photophobia (light sensitivity).

  • Red, swollen eyelids.

  • Red and irritated eyes.

It can, however, cause more severe symptoms such as missing or misdirected eyelashes, blurred vision, and inflammation of other eye tissue, particularly the cornea. In addition, a secondary infection can occur if they touch and rub the irritated area.

How Is Blepharitis Diagnosed?

Blepharitis is difficult to diagnose because various conditions can cause it. There is no single test for this condition. A thorough eye examination can be used to diagnose blepharitis. Testing may include the following, with a focus on the eyelids and the front surface of the eyeball:

  • Patient history is taken to determine any symptoms the patient is experiencing and any general health issues that may be causing the eye problem.

  • An external eyelid examination is done. The appearance of the eyelids and the degree of reddening, discharge, and swelling will aid in determining the type and severity.

  • A swab of eyelid secretion is sent to a lab for culture testing, which helps determine the contents, including the type and quantity of bacteria present.

  • A tear test may be performed, during which a tear sample can be used to determine whether the dry eye is a factor.

  • An eyelash exam can be done, during which mites can be detected by examining eyelashes under a microscope.

  • In some rare cases, extreme swelling may necessitate a biopsy to rule out skin cancer or other abnormal cells. The location of the area being tested determines the type of biopsy. The eye doctor will use a local anesthetic to numb the lid. The cells are then sampled using a needle biopsy and examined under a microscope. There may be some bruising, but there is generally little to no scarring.

How Is Blepharitis Treated?

The type of blepharitis will determine the treatment. The doctor may prescribe the following treatments after examining the eyelid swelling and running tests:

  • Antibiotics: Applying bacitracin ophthalmic ointment to the eyelids or using prescription antibiotic eye drops, such as the combination of Polymyxin B and Trimethoprim, may help resolve the bacterial infection and reduce irritation. For more severe cases, an oral antibiotic may be prescribed.

  • Anti-Inflammatories: A steroid eye drop or cream can also be added to the treatment plan. Steroids are used to treat inflammation. Antibiotics and anti-inflammatories are sometimes prescribed to treat underlying conditions or secondary infections.

  • Immunomodulators: In cases of posterior blepharitis, adding an immunomodulatory drug, such as Cyclosporine, has been shown to reduce inflammation. These medications inhibit the body's natural immune response, reducing inflammation.

  • Treatment of the Underlying Cause: In addition to treating symptoms, it is critical to address the underlying causes of blepharitis. Blepharitis can be exacerbated by skin conditions such as dandruff or eye ailments such as dry eye. A dandruff shampoo or eye drops for dry eyes may be beneficial in these cases.

What Are the Complications of Blepharitis?

Although blepharitis cannot be cured, it can be treated and controlled with proper eyelid hygiene. However, blepharitis, if left untreated, can lead to more serious eye conditions, such as corneal problems, which can be severe.

  • Chalazion: A chalazion is a small, painless swelling of the eyelid.

  • Corneal Ulceration: A corneal sore can develop due to a long-term infection or swelling of the eyelids.

  • Eyelash Problems: As a result of chronic blepharitis, eyelashes may shed, grow in unusual directions, or lighten.

  • Pink Eye: Some forms of blepharitis can progress to chronic pink eye.

  • Stye: It is a painful red bump on the lower eyelid near the lashes.

  • Tear Film Issues: Tears are a delicate balance of mucous, oil, and water that keep the eyes moist and protected. Dry eyes or excessive tearing can occur if skin or oily debris accumulates and cause irritation.


Blepharitis and its symptoms, such as swollen, red eyelids, are never pleasant. However, in most cases, it is a manageable condition. In many cases, good hygiene can aid in the treatment of blepharitis. In addition, antibiotics and other medications may be prescribed if a bacterial infection is associated with blepharitis.

Dr. Asha Juliet Barboza
Dr. Asha Juliet Barboza

Ophthalmology (Eye Care)


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