Blepharitis: causes, symptoms and how to relieve it

Blepharitis is a chronic inflammation of the eyelid margins, one of the most common eye conditions seen in consultation. It causes red eyelids, crusting at the base of the lashes, a gritty sensation and eyes that are stuck together on waking. It does not clear up: keeping it under control relies above all on regular eyelid hygiene, maintained over the long term.

UNDERSTANDING

What is blepharitis?

Blepharitis is an inflammation of the free margin of the eyelids, the area where the lashes are rooted and where small glands open. It is a very common condition, often chronic, that flares up in episodes. It is bothersome and sometimes unsightly, but in the vast majority of cases it remains harmless to vision.

The eyelid margin is home to two key structures: the base of the lashes, with its sebaceous glands, and the meibomian glands, lined up just behind the lashes. These glands produce the oily part of the tears, the layer that stops the tear film from evaporating too quickly. When this area becomes inflamed or disrupted, blepharitis sets in.

Two main forms are classically distinguished, and they often coexist in the same patient:

• Anterior blepharitis: it affects the outer edge of the eyelid, at the base of the lashes. It is often linked to bacteria (the so-called staphylococcal form) or to greasy dandruff-like flakes (the seborrhoeic form).
• Posterior blepharitis: it corresponds to meibomian gland dysfunction (MGD). The glands become blocked and secrete a thickened, poor-quality oil, which destabilises the tear film.

Blepharitis, which is diffuse and chronic, should not be confused with a stye or a chalazion, which are localised lesions of a single eyelid gland. Poorly controlled blepharitis does, however, encourage these small lumps to appear.

SYMPTOMS

What are the symptoms of blepharitis?

Blepharitis shows itself through red, irritated eyelids, a burning or gritty sensation in the eyes, crusting at the base of the lashes and eyes that are often stuck together on waking. Symptoms come in flares and usually affect both eyes. They are typically more pronounced in the morning.

Signs at eyelid level

The eyelid margin is the first area affected. You will often see:

• Redness and thickening of the eyelid margin
• Crusts or scales clinging to the base of the lashes, like dandruff
• Eyelids stuck together on waking, hard to open
• Lashes that fall out or sometimes grow crookedly, in long-standing forms

Signs at eye level

Because blepharitis destabilises the tear film, it is frequently accompanied by signs of ocular dryness and irritation:

• A gritty or foreign-body sensation
• Stinging, burning and discomfort in bright light
• A paradoxical watering: the eye waters even though it is dry, as a reaction to the irritation
• Vision that blurs at times, clearing again after a blink

These symptoms fluctuate from one day to the next. They often worsen in dry environments, in front of screens or with prolonged contact-lens wear. Blepharitis and screen-related dry eye feed off each other.

A chronic nuisance, rarely serious — blepharitis is uncomfortable and recurrent, but it does not usually threaten sight. On the other hand, a painful redness, a lasting drop in vision or marked sensitivity to light are not down to simple blepharitis and warrant an ophthalmological examination.

CAUSES

What are the causes and contributing factors?

Blepharitis most often results from an imbalance of the eyelid margin: overgrowth of bacteria that are normally present on the skin, disruption of the meibomian glands or excess sebum. There is no single cause, but rather a set of factors that keep the inflammation going, which explains its chronic nature.

Meibomian gland dysfunction

This is the most common cause of posterior blepharitis. The meibomian glands become blocked and the oil they produce turns thick and poor in quality. The tear film, poorly protected, evaporates faster: the eye becomes dry and irritated, which keeps the inflammation of the eyelid margin going.

The link with rosacea and the skin

Rosacea, a common skin disease affecting the face (redness of the cheeks and nose), is often associated with blepharitis. Seborrhoeic dermatitis (oily skin, dandruff of the scalp and eyebrows) also favours the anterior form. Treating the skin often improves blepharitis.

Other contributing factors

Several situations sustain or trigger blepharitis:

• Wearing contact lenses and eye make-up that is poorly removed
• Prolonged screen work, which reduces how often we blink
• Dry, air-conditioned or heated environments
• Age: the meibomian glands become disrupted more readily over time
• The presence of Demodex, a microscopic mite living at the base of the lashes

DIAGNOSIS

How is the diagnosis made?

The diagnosis of blepharitis rests on examining the eyelids with a slit lamp, a microscope that allows the lash margin to be observed closely. This examination is not painful. The ophthalmologist looks for crusting, the state of the meibomian glands and the associated signs of dry eye.

The slit-lamp examination

With the slit lamp, the ophthalmologist inspects the eyelid margin: redness, thickening, crusting around the lashes, the appearance of the meibomian gland orifices. By pressing gently on the eyelid, they assess the quality of the secretions: fluid and clear normally, thick or pasty in the case of dysfunction. They also examine the surface of the eye to assess the impact.

Assessing the ocular surface

As blepharitis often goes hand in hand with dryness, the ophthalmologist may add a tear-film assessment: measuring the tear break-up time, staining the surface, examining the glands. This assessment clarifies the share of associated dryness and guides management. It also helps rule out other causes of redness or irritation.

In consultation, whether in Cachan or in Paris 13, I systematically examine the eyelid margin with the slit lamp and assess the meibomian glands. This is what allows me to distinguish anterior blepharitis from gland dysfunction, and therefore to tailor the hygiene care and the treatment.

MANAGEMENT

How can blepharitis be relieved and treated?

Managing blepharitis rests above all on daily eyelid hygiene, kept up over the long term. Warm compresses, massage and cleaning of the lash margin form the cornerstone of treatment. Artificial tears provide relief, and medication is added only in certain situations, on prescription.

Eyelid hygiene, the mainstay of treatment

This is the key to controlling blepharitis, usually to be carried out once or twice a day, then once a day as maintenance. It takes place in three stages:

• Warmth: apply a warm compress (or a heated mask) to the closed eyelids for a few minutes, to soften the thickened secretions of the glands.
• Massage: gently massage the upper eyelid downward and the lower eyelid upward, always towards the lash margin, to help the meibomian glands empty.
• Cleaning: clean the lash margin with a compress or a suitable product, to remove crusts and scales.

This routine calls for consistency. The effects are not immediate: it often takes several weeks before a clear improvement is felt, and maintenance remains necessary afterwards to avoid relapses.

Artificial tears

Artificial tears, preferably preservative-free, relieve the sensation of dryness and irritation that comes with blepharitis. They do not treat the cause, but they clearly improve day-to-day comfort. They can be used as often as needed, particularly during screen work.

Medication, on prescription

In more pronounced or resistant forms, the ophthalmologist may prescribe additional treatment:

• A topical antibiotic (ointment or eye drops) on the eyelids during flares
• A topical anti-inflammatory, for a short and supervised period
• An oral antibiotic for its anti-inflammatory effect, in certain forms associated with rosacea
• Management of the associated rosacea or seborrhoeic dermatitis, in collaboration with the dermatologist

These treatments come in addition to eyelid hygiene, never in its place. That is why regular care remains, in every case, the most important point.

OUTLOOK

Can blepharitis be cured for good?

Blepharitis is a chronic condition: it is well controlled, but it does not disappear permanently. Symptoms improve clearly with regular care, then tend to return if eyelid hygiene is stopped. The aim is therefore to soothe it and maintain this result, not to make it vanish for ever.

This reality can be disappointing, but it is also reassuring: when properly followed, the hygiene routine allows most patients to live comfortably, with flares that are rarer and shorter. Blepharitis is managed rather like sensitive skin: through regular habits, rather than a one-off treatment.

If you are unsure about your symptoms, an ophthalmologist makes the diagnosis and tailors the care. They also check that it is not another cause of redness or irritation requiring different management.

FAQ

Frequently asked questions

Sources

1. Société Française d’Ophtalmologie (SFO). Pisella P-J, Baudouin C, Hoang-Xuan T (dir.). Surface oculaire. Rapport SFO 2015 — chapitre 4, « Les dysfonctionnements meibomiens et blépharites », et chapitre 22, stratégies thérapeutiques. sfo-online.fr/rapport/surface-oculaire-rapport-sfo-2015
2. American Academy of Ophthalmology (AAO). Amescua G, Akpek EK, Farid M, et al. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019;126(1):P56-P93. PMID 30366800
3. International Workshop on Meibomian Gland Dysfunction. Nelson JD, Shimazaki J, Benitez-del-Castillo JM, et al. Report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930-1937. PMID 21450914

Further reading

• Dry eye, remote working and screens: how to relieve your eyes
• Consulting an ophthalmologist in Paris
• Book an appointment at the practice

Cachan practice · Tel. +33 1 45 47 08 11
Paris 13 practice · Tel. +33 1 89 31 30 60

Medical disclaimer

This article is for information purposes. A personalised ophthalmological opinion remains essential for any therapeutic decision.

This article is intended for general information and is not a substitute for a medical consultation. Diagnosing blepharitis and choosing the care require an ophthalmological examination of the eyelid margin with a slit lamp. In the event of a painful redness, a drop in vision or persistent discomfort despite hygiene care, consult an ophthalmologist.