Blepharitis: Types, Causes, Symptoms, Diagnosis, and Treatments

Published on October 9th, 2023

Updated on April 29th, 2024

Blepharitis is an eye condition that causes inflammation of the eyelids due to bacteria and/or problems with the oil glands in the eyes. There are two types of blepharitis, anterior and posterior which affect different parts of the eye and have different causes. Signs and symptoms of blepharitis may be red eyes, swollen eyes, crusted eyelashes and burning eyes. The causes of blepharitis include seborrheic dermatitis, ocular rosacea, an eye infection and dry eyes. Treatments for this eye condition can involve keeping the eyes clean as well as using eye drops, antibiotics and specific blepharitis medication. Continue reading to learn more about blepharitis types, causes, symptoms, diagnosis, and treatments.

What is Blepharitis?

Blepharitis refers to the inflammation of the eyelids and is often characterised by red or swollen eyelids that may also be itchy, sore or burn. Blepharitis is commonly caused by bacteria that collects at the base of the eyelashes, or in the glands near the eyelids, according to Health Direct. Other causes of blepharitis include dry eyes, allergies and mites in the eyelashes. Blepharitis commonly occurs in both eyes and is not contagious. In summary, the answer to what is blepharitis is eyelid inflammation.

What Does Blepharitis Look Like?

Blepharitis can look different depending on the specific case, but in general, a person with blepharitis will have irritated-looking red eyes that may be swollen and have crusty eyelashes. A person may also have greasy eyelids and skin flaking around the eyes. The below image demonstrates what an eye looks like when affected by the eye condition blepharitis.

An eye demonstrating blepharitis with red eyes and crust at the base of the eyelashes.

What is the Other Term for Blepharitis?

The other terms for blepharitis include granulated eyelids and meibomitis. Meibomitis is used to refer to posterior blepharitis which affects the inner part of the eyelid. Meibomitis, also known as meibomian gland dysfunction (MGD), is a group of disorders that have functional abnormalities of the meibomian glands, which are the glands found along the rim of the eyelids. More general terms for blepharitis include eyelid swelling and eyelid inflammation.

What Part of the Eye Does Blepharitis Affect?

The parts of the eye blepharitis affects are the eyelids, the eyelashes and the oil glands in the eyes and both eyes are typically affected by blepharitis. Blepharitis is an inflammation of the eyelids, commonly caused by bacteria that gather in the eyelashes or glands of the eyelid, according to Health Direct. The oil glands that are affected are the part of the eye near the base of the eyelashes.

What are the Different Types of Blepharitis?

There are two different types of blepharitis which are anterior blepharitis and posterior blepharitis, according to the National Eye Institute. Anterior blepharitis affects the part of the eye where the eyelashes meet the eyelid. The causes of anterior blepharitis include bacteria on the skin, dandruff from the scalp or eyebrows and rarely, allergies or mites can lead to this eye condition. Posterior blepharitis affects the inner part of the eyelid that touches the eyeball. Posterior blepharitis can be caused by clogged oil glands in the eyelids and also by common skin conditions such as scalp dandruff and rosacea.

How Common is Blepharitis?

Blepharitis is a common eye condition with a 2009 survey of optometrists and ophthalmologists reporting that 37%-47% of patients exhibited signs of blepharitis. If you suspect you have blepharitis, book an appointment with an optometrist who can provide a diagnosis and treatment if necessary.

Who is at Risk of Having Blepharitis?

There are certain people who may be more at risk than others of developing the eye condition blepharitis. According to the American Academy of Ophthalmology, people with dandruff, oily skin or rosacea are more at risk of developing blepharitis. People who have allergies that affect their eyelids may also be at risk of having blepharitis. According to the Cleveland Clinic, other risk factors for blepharitis include wearing contact lenses, diabetes, living or working in a dry environment and going through hormonal changes or menopause.

What are the Causes of Blepharitis?

There are many different causes of blepharitis which can lead to anterior or posterior blepharitis. The causes of blepharitis include seborrheic dermatitis, ocular rosacea, dry eyes, eye allergies, blocked oil glands in eyelids, lice or mites in eyelashes and eye infections. The causes of blepharitis and their definition are listed below.

Seborrheic dermatitis: Seborrheic dermatitis is a skin condition that typically causes dandruff on a person's scalp but can also occur in the eyebrows.
Ocular rosacea: Ocular rosacea is a type of rosacea that specifically targets the eyes and can cause blepharitis.
Dry eyes: Dry eyes is a common eye condition that causes the eyes to become dry and irritated which may lead to blepharitis as it can cause an infection.
Eye allergies: Eye allergies that affect the eyelashes may cause blepharitis and can include allergic reactions to contact lens solutions, eye makeup or eye medications.
Blocked oil glands in eyelids: Blocked oil glands near the eyelids can cause blepharitis as the build-up of oil and bacteria may irritate the eyelid area.
Lice or mites in eyelashes: Lice or mites in the eyelashes may cause blepharitis due to the bacteria they carry, or the way they can block the glands near the eyelids.
Eye Infections: Eye infections, commonly bacterial eye infections can cause blepharitis.

If you are unsure what causes your blepharitis, book an appointment with an optometrist so they can provide options for treatment.

1. Seborrheic Dermatitis

Seborrheic dermatitis is a skin condition that typically causes dandruff on a person's scalp but can also occur in the eyebrows and the eyelids. According to Chicago Medicine, this condition is the most common cause of blepharitis as it leads to oily secretions and can affect both layers of the eyelid. According to the National Eczema Association, seborrheic dermatitis is a chronic form of eczema with symptoms such as flaking skin, rash and itchiness. This condition may go away on its own or can be treated with medicated shampoo.

2. Ocular Rosacea

Ocular rosacea is a type of rosacea that specifically targets the eyes and can cause blepharitis. Rosacea is an inflammatory skin condition often affecting the face, that causes redness, flushing, small visible blood vessels, and bumps or pimples on the face, according to Health Direct. Ocular rosacea is a type of rosacea that specifically targets the eyes and can cause redness, itching or inflammation around the eyes, including the eyelids, which can cause blepharitis.

3. Dry Eyes

Dry eyes is a common eye condition that causes the eyes to become dry and irritated which may lead to blepharitis as it can cause an infection. According to the Cleveland Clinic, dry tear ducts may alter the bacterial resistance in a person's eye which may result in an infection that subsequently leads to blepharitis. According to the American Academy of Ophthalmology, dry eyes is present in approximately half of the patients with staphylococcal blepharitis, which is a type of anterior blepharitis. Dry eyes may be treated with artificial tears to bring moisture to the surface of the eye.

A person with dry eyes that has caused blepharitis.

4. Eye Allergies

Eye allergies that affect the eyelashes may cause blepharitis and according to the Mayo Clinic, blepharitis caused by allergies can include allergic reactions to contact lens solutions, eye makeup or eye medications. Blepharitis is also associated with allergic conjunctivitis which is a type of conjunctivitis that is caused by an allergic reaction to irritants such as pollen, dust or animal dander as opposed to a virus or bacteria. The types of eye allergies are perennial allergic conjunctivitis, vernal keratoconjunctivitis, seasonal allergic conjunctivitis, contact allergic conjunctivitis, giant papillary conjunctivitis and atopic keratoconjunctivitis.

5. Blocked Oil Glands Near Eyelids

Blocked oil glands near the eyelids are one of the most common causes of blepharitis, as the blocked gland can lead to oil and bacteria build up along the eyelid. Blocked oil glands refer to the meibomian glands, which are located at the edge of the eyelids, becoming blocked. According to NHS East Sussex Health Care, the meibomian glands produce oil that stops the tear film from drying out. If the oil glands are blocked, this can lead to a build-up of bacteria and oil along the eyelid which can irritate the eyelid area and lead to blepharitis. Blocked oil glands may also lead to dry eyes.

6. Lice or Mites in Eyelashes

Lice or mites in the eyelashes can cause blepharitis. Demodex mites are one of the most common types of mites involved in causing blepharitis, with one study discovering that 30% of blepharitis cases involved Demodex mites according to the Cleveland Clinic. Demodex mites can block eyelash follicles and glands in your eyes, which can lead to blepharitis, according to the Cleveland Clinic. Demodex mites may also cause blepharitis by triggering an inflammatory response in the body, including rosacea, which can lead to blepharitis. The inflammatory response that Demodex mites cause in the body is due to the bacteria that these mites carry on their body, such as Streptococci, according to Liu, Sheha and Tseng in an article published in the National Library of Medicine.

7. Eye Infections

Eye infections, usually bacterial infections, can cause blepharitis. A bacterial eye infection is an infection of the eye that has been caused by bacteria. An eye infection may also be caused by a virus or less commonly by fungus. According to Queensland Children’s Hospital, blepharitis is often caused by a bacterial infection of the eyelashes, usually with the bacteria staphylococcus.

Do Bad Hygiene Practices Cause Blepharitis?

Yes, bad hygiene practices may cause chronic blepharitis according to Johns Hopkins Medicine, however, it may be a small part of why people develop this eye condition. There are other common causes, some of which are out of a person’s control. Practising proper hygiene and routinely cleaning the eyes is important and should be prioritised in order to protect the eyes from possible eye conditions. Using a warm compress or simply washing the eyes with water to get rid of impurities can be very effective and beneficial.

What are the Signs and Symptoms of Blepharitis?

The signs and symptoms of blepharitis are vast and vary depending on the type and severity. The blepharitis symptoms include red eyes, blurred vision, burning eyes and itchy eyes, trichiasis, swollen eyelids, teary eyes, greasy eyelids, light-sensitive eyes, crusted eyelashes, blinking more often and skin flaking around the eyes. The signs and symptoms of blepharitis and their definitions are listed below.

Red eyes: Red eyes may be a symptom of blepharitis due to inflammation and infection of the eyes which may turn the white part of the eye slightly or visibly red.
Blurred vision: Blurred vision is a symptom of blepharitis that may improve with blinking as it causes issues with the cornea and tear film which interferes with vision.
- Burning and itchy eyes: Burning or itching eyes can be a symptom of blepharitis, caused by inflammation or infection.
Trichiasis: Trichiasis may be a common symptom of chronic blepharitis which causes a person’s eyelashes to grow towards the eye instead of away from it.
Swollen eyelids: Swollen eyelids are one of the main symptoms of blepharitis as this eye condition is the inflammation of the eyelids.
Teary eyes: Teary eyes, also known as watery eyes, is a possible symptom of blepharitis, characterised by an excess of tear production.
Greasy eyelids: Greasy eyelids can be a symptom of blepharitis where the eyelids appear oily or greasy.
Crusted eyelashes: Crusted eyelashes are a symptom of blepharitis that is caused by oily particles or flakes that are wrapped around the eyelashes.
Blinking more often: People with eye infections such as blepharitis, may blink more often as the surface of the eyes can be dry, meaning a person may blink more to add moisture.
Skin flaking around the eyes: Skin flaking around the eyes is a common symptom of blepharitis that is very similar in appearance to dandruff.

1. Red Eyes

Red eyes may be a symptom of blepharitis due to inflammation and infection of the eyes which may turn the white part of the eye slightly or visibly red. Red eyes are a very common symptom of eye conditions such as conjunctivitis, dry eyes, eye allergies and a stye. This symptom is typically accompanied by itching, swollen eyes and irritated eyes and may be treated with lubricating eye drops.

2. Blurred Vision

Blurred vision is a symptom of blepharitis that may improve with blinking as it causes issues with the cornea and tear film which interferes with vision. Blurred vision is often associated with chronic blepharitis along with another visual symptom, photophobia. According to the National Eye Institute, blurry vision is considered a serious symptom and should be examined by an optometrist or healthcare professional.

3. Burning and Itchy Eyes

Burning and itchy eyes are symptoms of blepharitis that are caused by inflammation or an infection. Burning eyes refers to a sensation of stinging or irritation in the eye. Itchy eyes refer to a scratchy feeling in the eye. Burning and itchy eyes are a common symptom of blepharitis as the inflammation of the eyelid can irritate the eyes.

4. Trichiasis

Trichiasis may be a common symptom of chronic blepharitis which causes a person’s eyelashes to grow towards the eye instead of away from it as they normally should. Trichiasis can cause eye irritation as the eyelashes scrape the cornea, conjunctivitis and the underside of the eyelids, according to the Cleveland Clinic. This condition typically affects the lower eyelids and in severe cases may result in blindness as it can scratch the cornea.

5. Swollen Eyelids

Swollen eyelids are one of the main symptoms of blepharitis as this eye condition is the inflammation of the eyelids. Swollen eyelids refer to the eyelids becoming puffy, or larger. Eyelid swelling occurs as the result of an accumulation of fluid in the tissues of the eyelid in response to the inflammation and irritation of the eyelids.

A person with swollen eyelids caused by blepharitis.

6. Teary Eyes

Teary eyes, also known as watery eyes, is a possible symptom of blepharitis, characterised by an excess of tear production. Teary eyes refer to eyes that are secreting an excessive amount of tears. Teary eyes can be caused by eye or eyelid irritations. Teary eyes may also occur if blepharitis has been caused by dry eyes, as the eye attempts to produce more tears to add moisture to the surface of the eye.

7. Greasy Eyelids

Greasy eyelids can be a symptom of blepharitis where the eyelids appear oily or greasy. This symptom can occur due to oil build-up in the eye caused by an overproduction of the meibomian glands which are located along the edge of eyelids. Blepharitis is common in people who have oily skin and have issues with oil glands.

8. Crusted Eyelashes

Crusted eyelashes are a symptom of blepharitis that is caused by oily particles or flakes that are wrapped around the eyelashes. They appear as dandruff-like flakes that should be cleaned away daily with warm water or baby shampoo to help treat blepharitis. Crusted eyelashes are more commonly present when a person wakes up and may cause the eyelids to stick together.

9. Blinking More Often

People with blepharitis may blink more often as the surface of the eyes can be dry, meaning a person may blink more to add moisture to the eye. Blinking more often is also associated with the eye condition dry eyes which is often connected to blepharitis as these eye conditions have similar symptoms. Blinking more often can also be a response to an eye infection as the eyes are attempting to protect and clean the eye’s surface.

10. Skin Flaking Around the Eyes

Skin flaking around the eyes is a common symptom of blepharitis that is very similar in appearance to dandruff. According to the American Academy of Ophthalmology, bacteria at the base of a person’s eyelashes can lead to dandruff-like flakes forming around the eyes. These flakes can stick to the eyelashes and cause irritation. Flakes and crusts around the eyes should be cleaned away daily to help improve blepharitis.

How do Eye Doctors Diagnose Blepharitis?

Eye doctors, or more commonly optometrists, diagnose blepharitis through an eye test and in some cases by testing the skin around the eye. Within the eye test, the optometrist will take a thorough look at your eyes, specifically the eyelids and eyelashes. According to the Mayo Clinic, an eye care professional may swab the eyes to collect a sample of crust that forms on the eyelid or oil which can then be analysed for bacteria, evidence of an allergy or fungi. The optometrist will also examine where blepharitis occurs to determine if it is anterior (occurs at the root of the eyelashes) or posterior (occurs on the meibomian glands on the inside of the eyelid). According to the National Eye Institute, the optometrist will do a physical eye exam by closely examining the eye, specifically the eyelid and eyelashes.

How Long Does Blepharitis Last?

According to the South Eastern Sydney Local Health District, the symptoms of blepharitis can last up to 2-3 months before they start to improve as a result of treatment. If blepharitis and its symptoms persist for longer, it is recommended you see an eye care professional. People can also have chronic blepharitis which means they can have symptoms on and off for months to years, according to John Hopkins Medicine.

What Happens if Blepharitis is Left Untreated?

If left untreated, blepharitis can lead to corneal neovascularisation, ulceration, keratopathy and permanent alteration in the person’s eyelid, according to an article published in the National Library of Medicine. For treatment options, book an appointment with an optometrist who can assess the health of your eyes and prescribe the best treatment options for you.

What are the Treatments for Blepharitis?

Treatments for blepharitis include addressing the symptoms and also the underlying cause of the eye problem. The treatments for blepharitis include antibiotics, eye drops, warm compress, cleaning the eyes and taking omega-3 supplements. The treatments for blepharitis and their definitions are listed below.

Antibiotics: According to the National Eye Institute, antibiotics can be prescribed to treat blepharitis by fighting the infection if it is caused by bacteria. Antibiotics can come in the form of eye drops, pills or ointments and should be taken as your healthcare provider advises.
Eye drops: Steroid eye drops and artificial tears, also known as lubricating eye drops, can be used to treat blepharitis. Artificial tears add moisture to the surface of the eye and steroid eye drops help reduce blepharitis symptoms such as swelling, irritation and redness.
Warm compress: A warm compress is made up of warm water and a washer or cloth and is a simple treatment for blepharitis which can help with flaky and crusty eyelids. This treatment can also help keep oil glands in the eye from clogging, according to the American Academy of Ophthalmology.
Clean eyes: Having good hygiene and clean eyes can help treat blepharitis. It is important to routinely clean the eyelids of crusts and other irritants, preferably daily. To get rid of eye crusts, clean the eyes with warm water and gently wipe your eyelid and eyelashes.
Omega-3 supplements: Omega-3 supplements, also known as fish oil, can help people who have blepharitis as they can help oil glands found in the eyelids work better, therefore, treating blepharitis. Food sources of omega-3s include salmon and green leafy vegetables.

If you need more information on blepharitis treatments or how to treat a swollen eye, book an appointment with an optometrist.

The different treatments of blepharitis which are antibiotics, eye drops, warm compress, clean eyes and Omega-3 supplements.

Is There an Over-the-counter Medicine for Blepharitis?

Yes, there are over-the-counter blepharitis medications that can be used to treat this eye condition. Over-the-counter items a person can use to help with blepharitis symptoms include artificial tears, dandruff shampoo and omega-3 fatty acids. Over-the-counter items can be purchased without a prescription from a pharmacy or chemist. Artificial tears, also known as lubricating eye drops, add moisture to the surface of the eye and can help relieve eye irritation. Dandruff shampoo can be used to treat an underlying cause of blepharitis. According to the Cleveland Clinic, Omega 3s may help the oil glands in the eyes work better and can be purchased as supplements.

Can Eye Drops Help Treat Blepharitis?

Yes, eye drops can be used to help treat blepharitis, specifically artificial tears or steroid eye drops. Artificial tears add moisture to the surface of the eye. According to the American Academy of Ophthalmology, these eye drops can help reduce the symptoms of blepharitis such as swelling, irritation and redness. Antibiotic eye drops may also be prescribed by an eye care professional which helps the oil glands in the eye work better.

How to Prevent Blepharitis?

In many cases, blepharitis cannot be prevented as certain risk factors such as skin conditions are not controllable. According to Health Direct, blepharitis can reoccur in people who have already had it and ways to potentially prevent it from returning include keeping your eyelids clean and not using make-up around the eyes.

Can Eyeglasses Help Prevent Blepharitis?

No, eyeglasses cannot help prevent blepharitis as not only is blepharitis not preventable in most cases, glasses are not a treatment for this eye condition. However, according to the Cleveland Clinic, when dealing with blepharitis and its symptoms, it is recommended to wear glasses instead of contacts until it clears.

What is the Difference Between Blepharitis and Stye?

The difference between blepharitis and a stye is the area of the eye they affect. According to Very Well Health, both eye conditions can cause a person’s eyelid to be swollen and red but a stye, also known as a hordeolum, typically appears in one spot as a lump, whereas blepharitis usually affects the whole eyelid. Blepharitis can sometimes lead to a stye although the reverse is not likely. Blepharitis and a style have similar symptoms such as swelling and redness of the eye and can be painful. Treatments for these eye conditions include antibiotics and eye drops.

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