Learn about blepharitis, a common eyelid inflammation, its causes, symptoms, and effective treatment options on Meri Sehat.

Blepharitis

Overview

Blepharitis is defined as an inflammation of the eyelids. The term &quot;blephron&quot; originates from Greek and means eyelid, while &ldquo;-itis&quot; refers to inflammation. Blepharitis is an inflammatory condition of the eyelid margin that affects people of all ages and ethnicities. 
&nbsp;

Blepharitis can cause discomfort and irritation to the eyes and is generally not a threat to vision. However, it can result in permanent changes to the eyelid margin and potentially lead to vision loss due to complications such as corneal neovascularization, superficial keratopathy, and ulceration<a href="#accordion">[5]</a>.

Blepharitis is a common eye disorder in the United States, affecting more than 25 million Americans<a href="#accordion">[1]</a>. It is associated with loss of visual function and can result in damage to the eyelids and cornea. Severe inflammation may lead to corneal perforation. There are no known racial or gender differences in the incidence of blepharitis, but seborrheic blepharitis is more common in older individuals with an apparent mean age of 50 years. The disease also causes a loss of well-being and interferes with daily life activities<a href="#accordion">[1]</a>. 
&nbsp;

It can be categorized into three main types based on the location of the inflammation<a href="#accordion">[2]</a>:

Anterior Blepharitis: This type of blepharitis affects the front part of the eyelid, where the eyelashes are attached. It is often caused by bacterial infections or skin conditions such as seborrheic dermatitis. 
&nbsp;

Posterior Blepharitis: This type of blepharitis affects the inner part of the eyelid, where the meibomian glands are located. It is often caused by dysfunction of the meibomian glands, which can lead to excessive oil production and inflammation. 
&nbsp;

Angular Blepharitis: This type of blepharitis affects the corners of the eyes, where the eyelids meet. It is often caused by a bacterial infection and is also known as &quot;angular conjunctivitis&quot; or &quot;angular keratitis&quot;. 
&nbsp;

It&#39;s important to note that a person with blepharitis may have a combination of these types. 
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Signs and Symptoms

The signs and symptoms of blepharitis can vary, depending on the type of blepharitis. Some common signs and symptoms are: 
&nbsp;

1. Red, swollen, and itchy eyelids

2. Burning or stinging sensation in the eyes

3. Crusty or oily eyelashes

4. Flaking or scaling of the skin around the eyelids

5. Sensitivity to light

6. Blurred vision

7. Watery eyes

8. Eye fatigue or discomfort

9. Eyelid irritation or inflammation

10. Loss of eyelashes or misdirected eyelashes 
&nbsp;
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Causes

Blepharitis can result from infections, dysfunction of the oil-producing meibomian glands, or certain skin conditions.

The following are causes of anterior blepharitis:

Acne Rosacea: It is a chronic skin condition that causes redness, inflammation, and sometimes acne-like breakouts on the face, including the skin around the eyes. Thus, contributing to blepharitis. 
&nbsp;

Seborrheic Dermatitis (Dandruff): The skin condition causes flaking and scaling of the skin, which irritates the eyelids, causing inflammation.&nbsp; 
&nbsp;

Bacterial Overgrowth: Bacteria that normally reside on the skin can overgrow on the eyelids, leading to inflammation and irritation. 
&nbsp;

Eyelash Mites Or Lice: &nbsp;Demodex mites or lice are normally present inside the eyelash follicles. However, an overgrowth of these mites or lice can block the eyelash follicles and glands. 
&nbsp;

Allergies: Allergies to substances such as pollen,&nbsp; dust, eye drops, or contact lens solution can cause inflammation and irritation of the eyelids. 
&nbsp;

Environmental Factors: Exposure to smoke, dust, or other irritants can also contribute to the development of blepharitis. 
&nbsp;

Dry Eyes: Approximately 50% of patients with staphylococcal blepharitis have dry eyes<a href="#accordion">[5]</a>. Decreased tear production plays a role in altering bacterial resistance and increasing the risk of infections. 
&nbsp;

The following are causes of posterior blepharitis:

<ul>
	<li>Meibomian Gland Dysfunction: The meibomian glands are responsible for producing the oil that helps to lubricate the eyes. Dysfunction of these glands can lead to an imbalance in the tear film, causing inflammation of the eyelids.</li>
	<li>Dandruff: A condition in which the skin of the scalp starts to flake.</li>
	<li>Acne Rosacea: An inflammatory skin condition. 
	&nbsp;</li>
</ul>

The following are causes of angular blepharitis:

<ul>
	<li>Infection: caused by Staphylococcus and moraxella</li>
	<li>Allergic Neurodermatitis: A skin condition with features such as scaling or chronic itching</li>
	<li>Certain Drugs: Examples include chemotherapeutic agents and systemic retinoids. 
	&nbsp;</li>
</ul>

Diagnosis

There are no specific screening tests for blepharitis.

Blepharitis is typically diagnosed through a comprehensive eye examination. The ophthalmologist will review the patient&rsquo;s medical history and ask about their symptoms, including any eye or eyelid discomfort, itching, or redness. 
&nbsp;

During the eye examination, the doctor may perform the following tests:

<ul>
	<li>A visual acuity test to assess the vision.</li>
	<li>A slit-lamp exam to evaluate the front of the eye and eyelids under high magnification.</li>
	<li>An evaluation of tear film to determine if the patient has dry eyes.</li>
	<li>A swab or scrape of the eyelids to test for bacteria or mites that may be causing symptoms. 
	&nbsp;</li>
</ul>

The ophthalmologist or optometrist may perform additional testing, such as culturing the bacteria on the eyelids to identify the specific type of bacteria causing blepharitis. This can help determine the most effective treatment approach. 
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Treatment

The following is the treatment regimen for blepharitis<a href="#accordion">[3]</a> <a href="#accordion">[4]</a>: 
&nbsp;

<h5>Home Remedies</h5>

Self-care measures listed below contribute immensely towards treating blepharitis 
&nbsp;

Cleaning The Eyes

<ul>
	<li>Apply warm compresses to the closed eye to help loosen crusty deposits.</li>
	<li>Gently massage the eyelids with a clean washcloth or finger.</li>
	<li>Use a washcloth or cotton-tipped applicator with diluted baby shampoo or an eyelid cleanser to wash away oily debris or scales.</li>
	<li>Rinse the eyelids with warm water and pat them dry.</li>
	<li>Use a topical antibiotic ointment as advised by the doctor.</li>
	<li>Avoid eye makeup when the eyelids are inflamed.</li>
</ul>

Note: A good cleaning regime needs to be followed for life to keep Blepharitis under control. 
&nbsp;

Lubricating The Eyes

Use over-the-counter artificial tears to relieve dry eyes.

Control Dandruff and Mites:

<ul>
	<li>Use a dandruff shampoo if dandruff is contributing to blepharitis.</li>
	<li>Use tea tree oil shampoo on the eyelids daily or gently scrub lids once a week with 50% tea tree oil.</li>
</ul>

Note: Contact your doctor if you don&#39;t see improvement after six weeks and stop using tea tree oil if it irritates your skin or eyes. 
&nbsp;

<h5>Medication</h5>

If self-care approaches are ineffective, the doctor may prescribe medications, such as: 
&nbsp;

Antibiotics - To treat inflammation, antibiotics in the form of eye drops, creams, or ointments can be used to fight bacterial infections in the eyelids. If topical antibiotics are ineffective, oral antibiotics may be prescribed. 
&nbsp;

Steroids - Steroid eye drops or ointments may be prescribed to control inflammation, usually, after other treatments have failed. 
&nbsp;

Topical Cyclosporine - Medications that affect the immune system such as topical cyclosporine (Restasis) can help relieve some symptoms of blepharitis. 
&nbsp;

Treating Underlying Conditions - Treating underlying conditions such as seborrheic dermatitis or rosacea can help control blepharitis caused by these conditions. 
&nbsp;

<h5>Procedures</h5>

Several procedures can be used to treat blepharitis, including: 
&nbsp;

Intense Pulsed Light (IPL) Therapy - This procedure uses light energy to heat and unclog the oil glands in the eyelids, which can improve symptoms of blepharitis. 
&nbsp;

Thermal Expression - This procedure uses heat and pressure to unclog the oil glands in the eyelids, allowing them to function properly and reducing symptoms of blepharitis. 
&nbsp;

BlepharoExfoliation - This procedure involves the use of a small, rotating brush to clean the eyelid margins, removing debris and bacteria that contribute to blepharitis. 
&nbsp;

Thermal Pulsation - This procedure uses a device to apply heat to the eyelids, which can melt and remove blockages in the oil glands, improving symptoms of blepharitis. 
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If left untreated, blepharitis can lead to several complications that can affect eye health and vision. 
&nbsp;

Styes: Prolonged inflammation of the eyelids can lead to the development of styes, which are painful pus-filled bumps that form on the eyelid. 
&nbsp;

Chalazion: A chalazion is a firm, painless lump that develops on the eyelid due to inflammation of the meibomian glands. It can cause vision problems if it grows large enough to press against the eye. 
&nbsp;

Conjunctivitis: Blepharitis can also lead to conjunctivitis or pink eye, which is an inflammation of the conjunctiva (the thin, clear tissue that covers the white part of the eye). 
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Corneal Damage: In severe cases of blepharitis, inflammation, and irritation can damage the cornea (the clear, dome-shaped surface that covers the front of the eye), which can lead to vision problems. 
&nbsp;

Eyelash Loss: Chronic inflammation of the eyelids can cause the eyelashes to fall out or grow abnormally, which can affect the appearance of the eyes and lead to further irritation. 
&nbsp;

The following factors increase the risk of blepharitis:

<ul>
	<li>Acne rosacea</li>
	<li>Dandruff</li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a></li>
	<li>Contact Lenses</li>
	<li>Diabetes</li>
	<li>Exposure to irritants, like dust and chemicals</li>
	<li>Oily skin</li>
	<li><a href="https://merisehat.pk/disease/menopause">Menopause </a>or hormonal changes</li>
	<li>Certain medications, such as chemotherapy drugs</li>
	<li>Not removing makeup thoroughly</li>
	<li>Dry environments 
	&nbsp;</li>
</ul>
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The following measures can help prevent blepharitis or reduce the frequency of flare-ups. 
&nbsp;

1. Treat underlying conditions, such as dandruff, rosacea, or dry eye syndrome.

2. Avoid contact lenses and clean them properly.

3. Manage diabetes.

4.&nbsp;Artificial tears or lubricating eye drops in case of dry eyes.

5.&nbsp;Protective eyewear in dry or dusty environments.

6. Avoid rubbing the eyes.

7.&nbsp;Regular eye exams to detect any issues early on.

8.&nbsp;Practice good eyelid hygiene:

<ul>
	<li>Gently clean eyelids and lashes with a warm washcloth and mild cleanser.</li>
	<li>Keep eyelids clean and free of debris.</li>
	<li>Avoid touching eyes with dirty hands.</li>
	<li>Remove makeup thoroughly before going to bed.</li>
	<li>Avoid sharing towels or washcloths. 
	&nbsp;</li>
</ul>
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A small-scale study conducted in 2018, evaluated the effectiveness of tea tree oil (TTO) in treating eyelid conditions such as blepharitis and meibomian gland dysfunction. The researchers recruited 40 patients and split them into two groups. One group received eyelid scrubbing with a TTO formula, while the other group was treated with massage and cleansing. The researchers found that patients who received TTO treatment showed significant improvement in their symptoms, tear film stability, and lid signs, while those in the massage group showed minimal improvement. The study concluded that TTO is an effective treatment for eyelid conditions<a href="#accordion">[10]</a>&nbsp;. 
&nbsp;

Key Points

<ul>
	<li>Blepharitis is an inflammatory condition of the eyelid margin that affects people of all ages and ethnicities.</li>
	<li>It can cause discomfort and irritation to the eyes and is generally not a threat to vision.</li>
	<li>Blepharitis can result in permanent changes to the eyelid margin and potentially lead to vision loss due to complications such as corneal neovascularization, superficial keratopathy, and ulceration.</li>
	<li>Blepharitis is associated with loss of visual function and can result in damage to the eyelids and cornea. Severe inflammation may lead to corneal perforation.</li>
	<li>There are no known racial or gender differences in the incidence of blepharitis, but seborrheic blepharitis is more common in older individuals with an apparent mean age of 50 years.</li>
	<li>The exact cause of blepharitis is not fully understood, but there are several factors that may contribute to its development such as bacterial overgrowth, allergies, and other environmental factors, etc.</li>
	<li>Blepharitis is typically diagnosed through a comprehensive eye examination. The eye doctor will review the medical history and ask about symptoms, including any eye or eyelid discomfort, itching, or redness.</li>
	<li>Typically, it can be treated by home remedies. However, if self-care is not enough, medications and procedures to improve the condition may be the choice.</li>
</ul>

[1] R Scott Lowery MD. Adult blepharitis. Background, Pathophysiology, Epidemiology.

[2] Blepharitis. healthdirect

[3] Blepharitis. Mayo Clinic.

[4] Blepharitis. Blepharitis | Johns Hopkins Medicine.

[5] Blepharitis. EyeWiki

[6] Blepharitis (eyelid inflammation): Causes & treatment. Cleveland Clinic.

[7] Boyd K. What is blepharitis? American Academy of Ophthalmology.

[8] Kahn A. Eyelid inflammation (blepharitis): Causes, symptoms, and treatments. Healthline.

[9] Blepharitis: Medlineplus medical encyclopedia. MedlinePlus.

[10] Maher TN. The use of tea tree oil in treating blepharitis and meibomian gland dysfunction. Oman J Ophthalmol. 2018;11(1):11-15. doi:10.4103/ojo.OJO_205_2016