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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, artificial tears, or both are given.

Causes

Disorders that may cause blepharitis include staphylococcal infection of the eyelids or the ducts of the deeper glands that open at the edges of the eyelids, certain viral infections, and allergic reactions (to pollens or sometimes to eye drops). Skin conditions such as seborrheic dermatitis (see Itching and Noninfectious Rashes: Seborrheic Dermatitis) and rosacea (see Itching and Noninfectious Rashes: Rosacea) affect the face including the eyelids, leading to inflammation and blepharitis. Sometimes the inflammation has no known cause.

Spotlight on Aging Dry eyes are common among older people because tear production decreases with aging, especially among women. Exposure to a dry environment or to airborne irritants such as cigarette smoke can worsen the symptoms. Drugs are a common cause of dry eyes, as are eyelid disorders, especially blepharitis. Sjögren's syndrome, an uncommon autoimmune disorder sometimes associated with arthritis, can cause a severe dry eye. Sjögren's syndrome can also cause a dry mouth.

Blepharitis

Symptoms

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. The eyelids may swell, and some of the eyelashes may fall out. 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.

Blepharitis tends to recur and stubbornly resist treatment. It 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

Diagnosis is usually based on the symptoms and the appearance of the eyelids. A doctor may use a slit lamp (see Diagnosis of Eye Disorders: What Is 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 responsible and the antibiotics to which they are susceptible.

Treatment

Artificial tears and eye lubricant ointments (for use overnight) may help. The causative problem is treated when possible. For example, an eye drop that seems to be the cause can be stopped. Warm compresses placed over the closed eyelid may relieve symptoms and speed resolution. For blepharitis caused by seborrheic dermatitis, treatment usually includes keeping the eyelids clean by gently scrubbing the edges of the eyelids each 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). For inflamed oil glands at the edge of the eyelids, warm compresses may relieve inflammation, easing the itching and burning. Occasionally, a doctor may prescribe an antibiotic ointment, such as bacitracinSome Trade Names
BACIIM
plus polymyxin B ointment, gentamicin ointment, erythromycinSome Trade Names
E-MYCIN ERYTHROCIN
ointment, or sulfacetamideSome Trade Names
BLEPH-10
ointment, or an antibiotic taken by mouth, such as doxycyclineSome Trade Names
VIBRAMYCIN
. When seborrheic dermatitis is the cause, the face and scalp must be treated as well (see Itching and Noninfectious Rashes: Dermatitis). If rosacea is the cause, it also can be treated (see Itching and Noninfectious Rashes: Treatment).

Last full review/revision November 2007 by James Garrity, MD