Blepharitis
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What is blepharitis?
Blepharitis is a chronic inflammation of the eyelid margins - one of the most common conditions in ophthalmological practice. The inflammation can affect the anterior eyelid margin (around the base of the lashes) or the posterior eyelid margin (glands that maintain the tear film).
The condition is usually bilateral and prone to recurrence - it is not treated with a single visit to the doctor, but requires regular care and eyelid hygiene.
What types of blepharitis are there?
Anterior blepharitis affects the anterior margin of the eyelid - where the lashes grow. It may be:
Staphylococcal - caused by bacterial infection; hard, brittle scales (collarettes) form around the base of the lashes
Seborrhoeic - greasy, soft deposits around the lashes, similar to seborrhoeic dermatitis of the scalp
Mixed - a combination of both forms - the most common in practice
Posterior blepharitis affects the inner eyelid margin and the Meibomian glands - small glands in the tarsus that secrete the oily component of the tear film. There are two forms:
Meibomian seborrhoea - the glands secrete too much fluid, the tear film becomes unstable and frothy; this can cause a feeling of dry eye
Meibomitis - the glands are inflamed, their ducts become blocked, and the secretion becomes thick and cloudy; pressing on the eyelid may release a whitish-yellowish paste
How is it recognised?
Blepharitis symptoms are uncomfortable, but rarely dramatic - which is why patients often wait months before seeing a doctor.
Anterior blepharitis - symptoms:
Burning and stinging in the eyes
Moderate itching
Photophobia (sensitivity to light)
Increased tearing
Scales and deposits around the lashes (especially in the morning)
Redness and thickening of the eyelid margin
In advanced cases: loss of lashes (madarosis), deformity of the eyelid margins
Posterior blepharitis - symptoms:
Feeling of dryness and burning in the eyes
Itching and photophobia
Redness of the posterior eyelid margin
Frothy or cloudy discharge in the tear film
Plugs in the openings of the gland ducts - visible on examination
Many patients with blepharitis come in thinking they have "dry eye" - and they are not wrong, because long-term posterior blepharitis can indeed cause keratoconjunctivitis sicca (evaporative dry eye). A precise diagnosis reveals the true cause.
How is it treated?
Blepharitis is not cured with a single course of treatment - the key is regular eyelid hygiene combined with medication when necessary.
Eyelid margin hygiene is the foundation of treatment for both forms and must become a daily habit:
Warm compresses
In posterior blepharitis, gentle eyelid massage helps to drain the Meibomian glands
Medications:
Antibiotics in the form of eye drops or ointment - only when bacterial infection is confirmed (staphylococcus)
Low-strength corticosteroids (e.g. hydrocortisone) - to reduce inflammation, always combined with an antibiotic
Artificial tears - to compensate for the unstable tear film
Oral tetracyclines - in posterior blepharitis, to improve the quality of Meibomian gland secretions; treatment lasts weeks
What if it is not treated in time?
Without regular care, blepharitis can progress and lead to:
Ulceration of the eyelid margin (ulcerative blepharitis)
Permanent loss of lashes and deformity of the eyelid margins
Abnormal lash growth towards the eye surface - which can damage the cornea
Chronic dry eye due to a compromised tear film
Frequent styes and chalazia
Blepharitis is a chronic condition - symptoms may subside, but the disease does not disappear. Regular eyelid hygiene and occasional check-ups with an ophthalmologist prevent progression and complications.
Frequently asked questions
Is blepharitis contagious?
Blepharitis itself is not contagious. However, the staphylococcal form is caused by a bacterium that can be transmitted through touching with dirty hands or shared towels. Good personal hygiene and avoiding touching the eyes with dirty hands is recommended.
Can make-up worsen blepharitis?
Yes. Mascara, eyeliner, and eye shadow can block the Meibomian gland openings and worsen symptoms. Using hypoallergenic cosmetic products, removing make-up before bed, and temporarily avoiding eye make-up during acute phases are all recommended.
You do not have to put up with itching and burning eyes.
Blepharitis is a chronic condition - but with appropriate treatment and eyelid hygiene, symptoms can be effectively managed. Schedule an examination.