What is blepharitis? What causes it?

Kate Harris

Eye Health Advisor
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An introduction to blepharitis

Blepharitis is often a chronic condition where the eyelids become inflamed, usually affecting the edges of the eyelids, or ‘margins’ of the eyes. No easy cure can be found for most people suffering blepharitis, but treatment of symptoms and preventative measures can keep the condition under control. It is not contagious, and usually does not affect long-term eyesight.

Blepharitis can occur with different levels of severity, but for some the symptoms are constant and severe, which can impact upon daily life and reduce quality of life.

It can affect people of any age, though is most common in people over 40.

If you have been diagnosed with blepharitis and are looking for advice on the natural, herbal and conventional treatments available, have a look at our blepharitis treatments page.

What are the symptoms of blepharitis?

Symptoms of blepharitis can sometimes be confused with those of conjunctivitis, so if there is any doubt, see your GP for a correct diagnosis. In blepharitis:

  • Eyes may feel gritty or itchy and you may experience a burning sensation. In particular the eyelids may feel sore
  • Eyelashes may be crusty or greasy as a result of sticky discharge. This can also cause the eyes to stick together in the morning
  • Eyelid margins (edges) may be swollen
  • You may experience dry eyes
  • You my experience watery eyes
  • You may experience discomfort and irritation while wearing contact lenses.

What causes blepharitis?

Blepharitis can be classified as Anterior (more superficial) or Posterior (affecting deeper tissues in the eyelids). Each have different causes.

Anterior blepharitis affects the eyelashes and hair follicles. Common causes are:

  • Staphylococcal blepharitis is caused by the staphylococcus bacteria. This bacterium usually lives on our skin without causing any harm, but occasionally it can cause an infection. The exact reason why this bacteria gives rise to blepharitis in some but not others is not yet fully understood
  • Seborrhoeic blepharitis is similar to a skin condition called seborrhoeic dermatitis, which causes the skin to become oily and scaly. The underlying cause of this condition is also not clear, but it is thought that a particular kind of yeast is involved. In some people, this yeast causes the eyelids to become inflamed.
  • Demodex blepharitis is caused by Demodex mites – tiny microscopic parasites that live around hair follicles and sebaceous glands.

Posterior blepharitis involves poorly functioning oil-secretion glands on the edges of the eyelids:

  • Meibomian blepharitis is a kind of posterior blepharitis, as it affects the meibomian glands which lie just behind the eyelashes. These glands produce an oily substance which lubricates and protects the eyes. In some people, a problem develops with this gland such as a blockage or the production of poor quality oil, triggering an inflammatory response in the eye
  • Rosacea blepharitis is caused by a problem in the sebaceous glands. Rosacea can also affect the skin, causing pimples and facial redness. Again, the underlying causes of this type of blepharitis are not fully understood.

Sometimes blepharitis can be caused by a combination of more than one of these types, as each one exacerbates the other and makes the eye more vulnerable to infection, though usually one is the primary contributor to the condition.

Makeup can sometimes cause or exacerbate blepharitis as it can transfer bacteria onto the edges of the eyelid, and it can irritate them, causing an outbreak of symptoms. It is important, therefore, to maintain good eye makeup hygiene.

Complications of blepharitis

In some cases, other eye problems may arise as a result of blepharitis. These are not always serious, but there are some that may need medical attention. Complications of blepharitis include:

  • Chalazion (cyst) or stye. These are painful swellings appearing on the inside and outside of the eyelid. These can be easily treated and often resolve themselves
  • Changes to the development of eyelashes – eyelashes may fall out, lose colour or begin growing inwards, further irritating the eye
  • Conjunctivitis– this is where the thin layer of ‘skin’ on the front of the eye, the conjunctiva, becomes inflamed
  • Keratitis– this is an inflammation of the cornea that can cause ulcers and scarring, which, if left untreated, can cause damage to vision, or in some cases, blindness. This condition is rare, but serious, so if you experience eye pain beyond the usual itchiness and grittiness, you should seek immediate medical advice
  • Damage to the eyelid itself, such as scarring or ulcers.

What treatments are there for blepharitis?

For advice on the treatment of blepharitis, head to our blepharitis treatment page.

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