Blepharitis - Causes, Symptoms and Treatment


Dr.I P Singh profile Authored by Dr.I P Singh on 4 Feb 2015 - 13:06.

Chronic marginal blepharitis is a very common cause of visual discomfort and irritation. It leads to the inflammation of the eyelids causing the eyes to feel sore. It can be a troublesome and recurring condition for which there is no special cure. Blepharitis usually occurs when tiny oil glands located near the base of the eyelashes malfunction.



Blepharitis has two basic forms:

  • Anterior Blepharitis affects the area surrounding the bases of the eyelashes and could be staphylococcal (may be caused due to staphylococci bacteria) or seborrheic (a common skin disease that causes a red, itchy rash with white scales). Seborrhoeic blepharitis is often associated with generalized seborrhoeic dermatitis that may involve the scalp, nasolabial folds, behind the ears, and the sternum (chest).
  • Posterior Blepharitis, occurs when meibomian glands dysfunction within the eyelids that secrete oils to help lubricate the eye.



Anterior Blepharitis:

Burning, grittiness, mild photophobia, crusting and redness of the lid margins with remissions (reduced) or exacerbations (excessive) are characteristic. Some of the signs and symptoms seen are:

  • Hard scales and crusting mainly located around the bases of the lashes
  • Mild papillary conjunctivitis and chronic conjunctival hyperaemia are common. 

  • Long-standing cases may develop scarring and notching of the lid margin, madarosis (absence of eyelashes), trichiasis (abnormally positioned eyelashes that grow back toward the eye) and poliosis (decrease or absence of melanin (or color) in head hair, eyebrows, or eyelashes). 

  • Secondary changes include stye formation, marginal keratitis. 
Associated tear film instability and dry eye syndrome are common. 

  • Hyperaemic and greasy anterior lid margins with sticking together of lashes.
  • The scales are soft and located anywhere on the lid margin and lashes.

Chronic Posterior Blepharitis:

Pressure on the lid margin results in expression of meibomian fluid that may be turbid or toothpaste-like, in severe cases the secretions become so inspissated that expression is impossible. 



Anterior Blepharitis:

Keeping the eye hygienic is very important to address this problem. Antibiotics are also given depending on the severity of the condition.

Maintaining lid hygiene includes, applying a warm compress for several minutes to soften crusts at the bases of the lashes.

Lid cleaning to mechanically remove crusts involves scrubbing the lid margins once or twice daily with a cotton bud dipped in a dilute solution of baby shampoo or sodium bicarbonate.

Commercially produced soap/alcohol impregnated pads for lid scrubs are available but care should be taken not to induce mechanical irritation. The eyelids can also be cleaned with diluted 
shampoo when washing hair. 

Gradually, lid hygiene can be performed less frequently as the condition is brought under control but blepharitis often recurs if it is stopped completely. 

Antibiotics that can be administered are:

  • Topical sodium fusidic acid, bacitracin or chloram-phenicol is used to treat acute folliculitis but is of limited value in long-standing cases. Following lid hygiene, the ointment should be rubbed onto the anterior lid margin with a cotton bud or clean finger. Local lid margin massage with antibiotic ointment or a very limited massage with antibiotic/steroid combination eye ointment for a couple of days.
  • Oral azithromycin (500 mg daily for three days) may be helpful to control ulcerative lid margin disease.

** Weak topical steroid such as fluorometholone 0.1% q.i.d. for one week is useful in patients with severe papillary conjunctivitis, marginal keratitis and phlyctenulosis, although repeated courses may be required. 

** Tear substitutes are required for associated tear film instability and dry eye. 

Chronic Posterior Blepharitis :

Lid hygiene: Warm compresses and hygiene are performed as 
for anterior blepharitis except, with emphasis on massaging the lid to express accumulated meibum. It requires massaging toward the lid margin edge to ‘milk’ meibum and physical expression of the glands.

** Systemic tetracyclines are the mainstay of treatment but should not be used in children under the age of 12 years or in pregnant or breast-feeding women, because they are deposited in the growing bone and teeth, and may cause staining of teeth and dental hypoplasia (incomplete development) Erythromycin can be considered as an alternative.




*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.