Blepharitis: what is it and what does chronic inflammation of the eyelid entail?

By Cristiano Antonino On Mar 6, 2023

Blepharitis – from the Greek blepharon: ‘eyelid’ and -ite: suffix indicating inflammation – consists of chronic inflammation of the free edge of the eyelid

The most common symptoms include severe redness associated with itching and swelling, which may occur in only one or both eyes at the same time.

Blepharitis: the symptoms with which it manifests itself

The symptoms with which it manifests itself – most evident in the morning, after waking up – are typical of severe inflammation:

red, swollen eyelids
strong lacrimation
dryness
burning
itching
eye irritation
formation of dandruff-like scales near the ciliary follicle
sticky eyelids resulting in difficulty in opening them, especially in the morning
foreign body sensation in the eye
blurred vision
extensive inflammation of the eye with conjunctival and, in severe cases, corneal involvement
sensitivity to light

Because of this annoying symptomatology, before diagnosis one might think of a simple irritation, which leads the patient to start rubbing the inflamed area repeatedly in the vain hope of relieving the itchy sensation.

This inappropriate behaviour will only lead to an aggravation of the patient’s clinical picture.

Blepharitis: what causes it and who suffers from it

Blepharitis can be caused by:

skin diseases such as seborrhoeic eczema, rosacea, dermatitis, scalp dandruff affecting the face and consequently also the eyelids
bacterial infections, usually by staphylococcus or streptococcus, affecting the eye or tear ducts
viral infections often caused by herpes simplex
allergic reactions to eye drops
allergic contact reaction caused by poorly tolerated cosmetic products applied to the eyelids or eyelashes
eating disorders or digestive difficulties causing avitaminosis
diseases such as diabetes and hypercholesterolaemia
dry eyes
excessive tearing
parasites affecting the ciliary zone
environmental allergic factors (dust, smoke, mites, pollen)
obstruction and subsequent inflammation of the ducts of the glands that open at the eyelid margins
sometimes, the origin of the inflammation remains unknown

Blepharitis: diagnosis and the three different types of blepharitis

In order to make a correct diagnosis of the disease, the specialist – dermatologist or ophthalmologist – makes use in the first instance of a visual analysis of the clinical situation, also with the help of a slit lamp.

In cases where it is important for treatment purposes to reliably identify the pathogen responsible for the infection, the specialist may take a sample of biological material from the eyelid margin to be cultured.

Three different types of blepharitis can be identified on the basis of the visual analysis and that of the sample taken: anterior blepharitis, posterior blepharitis or mixed blepharitis.

Anterior blepharitis

A case of anterior blepharitis is diagnosed when the infection affects the front part of the eyelid, the part exposed outwards, at the base of the eyelashes. As external, it can be of bacterial origin, contact or caused by skin problems such as eczema or seborrhoeic dermatitis.

Posterior blepharitis

A case of posterior blepharitis is diagnosed when the infection affects the inner part of the eyelid, the part in contact with the eyeball.

It usually occurs when inflammation affects the Meibomian glands, structures that produce oily substances at the edge of the eyelids, just behind the lash rima.

When these small glands are clogged – by excess sebum or flakes of skin – they tend to become inflamed causing a case of internal blepharitis.

Mixed blepharitis

A case of mixed blepharitis is diagnosed when inflammation affects both the front and the back of the eyelid. This is the most common form of blepharitis.

Blepharitis: the most appropriate therapy

Blepharitis is not a disease that leads to complications that are difficult to eradicate.

Once diagnosed, it will be easy for the specialist to prescribe the correct treatment that – within a short time – will lead the patient to complete healing within a short time.

The healing time can be longer when blepharitis presents itself in its chronic form, i.e. when it appears at more or less regular intervals of time.

In this case there is no real definitive cure and healing times will be longer.

Therapy will therefore be aimed at reducing the peaks of the most painful symptomatology and the maintenance of correct eyelid hygiene will allow the problem to be substantially resolved.

When the blepharitis is of bacterial origin, the specialist prescribes antibiotics to be taken orally or in the form of eye drops to be applied in the eye or on the eyelid.

If the blepharitis originates from a contact allergy, it will be useful to trace the product that triggered it, and then proceed with antibiotic treatment.

If, on the other hand, the cause is a skin problem, it will be necessary – together with blepharitis – to also take care of the skin in order to prevent the blepharitis from becoming chronic.

At the same time, it can help to follow a few tips:

apply warm water compresses to the eyelid in order to make the oil more liquid, which blocks the inflamed glands inside the eye
massage the eyelids with well disinfected hands to drain any oily substances trapped in the Meibomian glands

Wipe the eyelids with a well-cleaned cloth or medicated gauze to remove any oil residue and accumulated dirt

Blepharitis: possible complications

As mentioned above, blepharitis is an inflammatory condition of the eyelid from which – with the correct treatment – it heals relatively quickly.

In some cases, however, complications can occur:

Dry eye syndrome

Manifests itself with dry, itchy and burning eyes due to insufficient production of certain components of the tear film for proper hydration of the ocular surface

Conjunctivitis

Inflammation of the conjunctiva covering the sclera of the eye and the inner eyelid.

Styes

Painful swelling caused by a bacterial infection favoured by the presence of blepharitis.

Chalazion or Meibomian cyst

Painful swelling that develops on the inside of the eyelids.

The cyst develops as a result of occlusion of the meibomian glands, which produce oily substances that – unable to purge – cause inflammation in the area.

Damage to the cornea

In the case of severe blepharitis, on which prescribed therapies have little effect, the inflammation may lead to damage to the cornea causing keratitis.

Chronic blepharitis

Present mainly in elderly patients, these are cases of blepharitis that recur at a more or less regular interval.

Blepharitis: how to prevent infection

To prevent the occurrence of blepharitis infection, it will be necessary to follow the most natural hygiene rules so as to avoid the risk of developing inflammatory states: always rinse your eyes with lukewarm water and dry them gently with a clean, dry cloth; lubricate your eyes often with artificial tears, especially if you spend most of your days in front of bright electronic devices (PCs, smartphones, tablets); check periodically for the presence of dandruff or oily components near the lash line; always wash your hands and nails thoroughly before touching your eyes; eat a diet rich in fresh fruit and vegetables, lean proteins and low in sugar and fat; always keep all personal devices that come into contact with your eyes, from clothes and underwear to make-up, clean and hygienic.

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