What Is Blepharitis? What Causes Blepharitis?

Blepharitis is inflammation usually involving the part of the eyelid where the eyelashes grow - the eyelid margins. The eyes can eventually become red, irritated and itchy, with dandruff-like crusts appearing on the eyelashes. Blepharitis occurs when the small oil glands near the base of the eyelashes don't work properly, either because of a bacterial infection or some complication of a skin condition, such as seborrheic dermatitis (seborrheic dermatitis that affects the scalp is called dandruff).

Blepharitis is a chronic (long-term, recurring) condition that is not easy to treat - lubricating drops often do little to improve the condition. As well as being uncomfortable it may also be unattractive. However, it does not generally cause any permanent vision damage.

There are two forms of blepharitis:

• Anterior blepharitis - the outside of the eyelid is affected; where the eyelashes are attached. Mainly caused by Staphylococcus (bacterium) and scalp dandruff.
• Posterior blepharitis - the moist inside part of the eyelid is affected. It is caused by problems with the Meibomian glands in this part of the eyelid. The Meibomian glands make a lubricant called sebum, which is discharged through tiny openings in the edges of the eyelids. Posterior blepharitis is mainly caused by rosacea and scalp dandruff (seborrheic dermatitis). Rosacea is a chronic, inflammatory skin condition which principally affects the face.

People commonly have repeated episodes of blepharitis - it is a chronic condition (either long term or keeps coming back).

According to the National Health Service (NHS), UK, approximately 5% of all GP (general practitioner, primary care physician) visits related to eye problems are cases of blepharitis. Blepharitis is not usually a serious condition and complications are very rare.

According to Medilexicon's medical dictionary:

Blepharitis is "Inflammation of the eyelids."

What are the signs and symptoms of blepharitis?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Typically, a patient will have recurring episodes of blepharitis, with long periods of total remission (no symptoms at all) in between. Signs and symptoms, which are usually more severe in the morning and affect both eyes, may include:

• Red, sore and itchy eyelids
• A burning sensation in the eyes
• A gritty/sandy sensation in the eyes
• Crusty eyelashes
• Eyelashes may grow abnormally (misdirected)
• Eyelids appear greasy
• Eyelids may stick together when waking up after sleep
• Flaky skin around the eyes
• Loss of eyelashes
• Photophobia - sensitivity to light
• Red eyes
• Watery eyes

What are the causes of blepharitis?

There are two types of blepharitis - anterior and posterior blepharitis:

• Anterior blepharitis - the outside front edge of the eyelids are inflamed; i.e. where the eyelashes are connected.
  
  A significant number of cases of anterior blepharitis are caused by a bacterial infection, specifically staphylococcal infection, known as staphylococcal blepharitis.
  
  Seborrheic dermatitis causes oily skin which may irritate the eyelids (excess oil), and also provide an ideal environment for bacteria to multiply rapidly. If it is caused by seborrheic dermatitis, it is called seborrheic blepharitis.
• Posterior blepharitis - the inside front edge of the eyelids are inflamed; where the eyelid comes into contact with the eye. Meibomian glands in this part of the eyelid produce an oily substance that makes up the top layer of our tears - the substance keeps the tears in place, as well as protecting the eye. Posterior blepharitis occurs when something affects the meibomian glands. The proper workings of these glands may be affected by rosacea or seborrheic dermatitis.
  
  Seborrheic dermatitis may cause the glands to produce excessive amounts of oil; providing an ideal environment where bacteria can multiply rapidly.
  
  Rosacea can result in the under-production of oil, leading to tears not properly protecting the eye, which becomes susceptible to infection. Ocular rosacea is rosacea that affects the eye. Approximately half of all patients with rosacea will have eye symptoms. According to the National Health Service (NHS), UK, patients taking antibiotics for rosacea will probably not develop ocular rosacea.
  
  The term Meibomian blepharitis refers to blepharitis cause by problems with the Meibomian gland.

Blepharitis may also be (rarely) caused by an infestation of lice on the eyelashes, or an allergic reaction to, for example, eye medications, contact lens solutions or eye makeup.

Diagnosing blepharitis

A GP (general practitioner, primary care physician), usually the first health care professional a patient will see, can usually diagnose blepharitis after asking the patient questions regarding symptoms, and carrying out a medical examination of the eyes; as well as checking for any medical conditions which may be linked to the condition, such as rosacea or seborrheic dermatitis.

If symptoms are particularly severe, or if the patient has any loss or vision, the GP may refer him/her to an eye specialist doctor (ophthalmologist). The doctor may sometimes collect a sample of crust or oil from the eyelid - this will be checked for bacteria, fungi, or perhaps an allergy.

What are the treatment options for blepharitis?

• Keeping the eyes clean - thorough eye hygiene is a crucial part of blepharitis treatment. Eyelids should be cleaned at least once a day, regardless of whether any symptoms are present. Experts say the ritual of eye hygiene should be followed as closely as body washing or brushing one's teeth. Good eye hygiene not only reduces the severity of blepharitis symptoms, but also how often recurrences occur.
  
  Patients with symptoms or those who risk recurrences of symptoms should place a warm compress over their closed eyelids for about five to ten minutes. The compress should be rubbed, very gently, over the eyelids for a couple of minutes - this will help dislodge the crusting.
  
  Using warm water with a tiny amount of baby shampoo, the eyelids should be cleaned with a cotton bud. A teaspoon of sodium bicarbonate dissolved in a cup of water is also possible. Some specific products are also available in pharmacies - ask your doctor or pharmacist. In order to prevent accidental injuries, the cleaning should be done in front of a mirror. If symptoms are severe the patient may have to do this several times a day.
  
  Eye makeup should be avoided, or at least cleaned off immediately after it is no longer needed.
• Antibiotic creams - the doctor may prescribe a four to six week course of antibiotic cream/ointment if the symptoms did not respond well enough to eye-hygiene treatment. When using the cream/ointment patients should avoid using contact lenses. Those who experience blurry vision should not drive.
• Oral antibiotics - the doctor may prescribe oral antibiotics if other treatments have not worked well enough. If the patient has rosacea, oral antibiotics will be prescribed if blepharitis symptoms develop. Most courses last for about six weeks. Patients should start experiencing positive results with two to four weeks. Prolonged exposure to sunlight should be avoided when taking antibiotics for blepharitis.
• Steroid eyedrops/ointments - these may help reduce inflammation in the eyes and eyelids.
• Artificial tears - if the eyes are dry, lubricating eyedrops or artificial tears may help.

If the blepharitis is caused by an underlying condition, that condition must be treated.

Even when treatment is successful, recurrences are common.

What are the possible complications of blepharitis?

• Misdirected eyelashes - blepharitis may cause eyelashes not to grow in the way they are supposed to. They may grow in unusual directions, or inwardly.
• Eyelid scarring - long-term blepharitis can eventually lead to scarring on the eyelids.
• Sty - a tender bump on the eyelid caused by an acute infection of the oil glands in the eyelid.
• Chalazion (Meibomian cyst) - one of the oil glands in the eyelid becomes blocked and infected with bacteria, causing swelling and reddening. It is like a sty, but occurs inside the eyelid.
• Conjunctivitis (pink eye) - There is a thin layer of cells (membrane) between the inner surface of the eyelids and the whites of the eyes, called the conjunctiva. Conjunctivitis is when the conjunctiva becomes inflamed. Another name for conjunctivitis is pink eye. Inflammation causes tiny blood vessels (capillaries) in the conjunctiva to become more prominent, giving the eye a red or pink look. People with blepharitis can suffer from recurrent episodes of conjunctivitis.
• Dry eye syndrome (keratoconjunctivitis sicca) - a common complication of blepharitis. Either the eyes do not make enough tears or they evaporate too rapidly, leading to eyes that dry out and become inflamed. Dry eye syndrome may occur because conditions linked to blepharitis, such as rosacea and seborrheic dermatitis may change the consistency of tears. Dry eyes are commonly treated with artificial tears which can be purchased OTC (over-the-counter, no prescription required) at pharmacies.