Blepharitis: What’s Behind Your Red, Itchy Eyes

Are your eyelids red and tender? Do your eyes itch and burn? Are you unusually sensitive to light?

These symptoms characterize blepharitis, one of the most common ocular diseases that, in mild cases, is hardly noticeable. In more severe cases, it can cause discomfort.

Blepharitis is not contagious, nor does it usually cause permanent damage to the eye.

But it can be unsightly and painful.

A scaly crusting can form on the eyelids and eyelashes — some call this “eye dandruff” — and sometimes leads to clogged glands, infections, blurry vision, and even lash loss.

About half of the patients seen by Thomas E. Johnson, M.D., an ophthalmologic surgeon at Bascom Palmer Eye Institute, have blepharitis. Of those, most don’t know they have it. They’re in the office for a surgery consultation or another eye condition.

I see it in patients of all ages, even children and young adults. A lot of patients say their eyes are itchy and red, and they get tired easily.  Sometimes, they’ve noticed a crustiness on their eyelids upon awakening. When I examine them, it often turns out to be blepharitis. It’s one of those diagnoses in ophthalmology you can actually see.

Blepharitis occurs when the normal eyelid glands, called Meibomian glands, get clogged, leading to the telltale signs that characterize the condition. Various diseases have been linked to it. These include rosacea, allergies, seborrheic dermatitis (dandruff), and even toxicity to medications or preservatives. 

Personal habits also play a part. Poor eyelid hygiene – not thoroughly removing makeup from your lashes and eyelids at bedtime, for example – can cause the tiny glands along our eyelids to clog.  Sleeping in your contacts is also a no-no. Trauma, whether physical, chemical, or surgical, can cause it to flare up as well. 

“Additionally, stress can trigger a flare-up,” Dr. Johnson adds. “So can not getting enough sleep. I often see blepharitis and chalazia [swelling or lump on the eyelid] in college students who are staying up late to study for exams and are feeling under stress.”

Tiny eyelash mites known as “Demodex” can cause blepharitis, too, and this is particularly worrisome for seniors. Demodex mites are found to some degree in almost everyone but can be associated with other skin conditions such as psoriasis, dermatitis and acne. They are especially common in older people. In fact, a study showed that about half of adults and two-thirds of older adults play host to these tiny parasites. In comparison, a third of children and young adults carry face mites.

There are two kinds of blepharitis: anterior and posterior.

Anterior blepharitis occurs in front of the eyelid and tends to affect mainly the eyelashes. The bacteria staphylococcus or something as simple as oily build-up can cause it. Posterior blepharitis, on the other hand, happens on the interior side of the eyelids, when the oil-producing glands in the inner eyelid known as Meibomian glands are inflamed.

Once inflamed, these glands produce either too little or too much of the oil essential in preventing rapid tear evaporation. As a result, eyes can feel dry or watery. Eyelids swell, and styes can develop.

The bad news: blepharitis is chronic.

The good news is that it’s a highly treatable condition, though one that requires vigilance.

A thorough eye examination by an ophthalmologist or optometrist can accurately diagnose the condition and suggest treatments to avoid complications. The go-to treatment can include such simple procedures as cleaning eyelashes and eyelids with baby shampoo or over-the-counter lid scrubs that come in disposable wipes or foams. Warm and moist compresses (think heat masks or washcloths) should be applied to closed eyelids as prescribed by the doctor, which will help open the eyelid glands and thin out the thickness of the gland oil so it drains more easily.

Medications (antibiotics or steroids) treat infection and inflammation, and in the case of dry eye, the use of lubricant drops several times a day helps. Tea-tree foam eyelid cleansers can be used and are available over the counter for Demodex mite infections.  For more serious cases, anti-parasitic eyedrops (Xdemvy) may also be prescribed.

More serious blepharitis cases require in-office procedures. Thermal pulsation, the gentle application of heat and massage to the eyelids, can break down gland clogs.

Good eyelid hygiene is the best way to prevent flare-ups.

“I tell my patients to make it part of their daily routine,” he says. “Just like you brush your teeth, you clean your eyelids.”

Here are his recommendations:

• Clean your eyelids and lashes twice a day using baby shampoo or commercial eyelid wipes. “Keep it in your shower so you can wash and rinse right there,” he says. Dr. Johnson practices what he preaches. He uses a Tea Tree oil foam that is labeled as a gentle eyelid formula.
• Take an omega-3 supplement if approved by your primary care physician. Omega-3 fatty acids serve as an anti-inflammatory and help clear the Meibomian glands. Foods high in omega-3s include walnuts, flax seeds, and salmon.
• Always remove your makeup before going to bed.
• Don’t sleep in your contacts.
• Wash your face and hands regularly.
• Avoid touching your eyes.
• Apply warm compresses for 20 minutes twice a day in the event of a flare up.

“It can be challenging to keep blepharitis under control,” Dr. Johnson adds, “but if treated early and properly, the symptoms are manageable. Patients are happy and grateful for the relief.” 

Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked at The Miami Herald, The Miami News, and The Palm Beach Post.

Tags: blepharitis symptoms, Blepharitis treatment, Dr. Thomas Johnson, Eyelid hygiene tips, Meibomian gland dysfunction, Red itchy eyes