Blepharitis | Medtick
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Blepharitis

What is it?

A long term condition where one’s eyelids become hot, red and swollen (inflamed) and is not contagious.

  • Anterior: inflammation of the base of the eyelashes (skin and lash), causation can be seborrheic, bacterial (staphylococcal) or demodex (face mites);
  • Posterior: meibomian gland dysfunction and or obstruction (may result in chalazion);
  • Mixed: elements of anterior and posterior are present

Blepharitis. BMJ Best Practice. November 2024. Accessed February 2025. https://bestpractice.bmj.com/topics/en-gb/574

.
Lin A, Ahmad S, Amescua G, et al. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2024;131(4):P50-P86. doi:10.1016/j.ophtha.2023.12.036

Diagnosis tests

  • Bacterial culture
  • Biopsy (rare)
  • Eyelash sampling (microscopy)
    • check for mites, bacterial and fungal, viral conditions
  • Meibomian gland evaluation
    • Gland expression test (checking oil quality)
    • Blockage or thickened secretions
    • Tear film instability tests
  • Skin evaluation – check for dermatitis conditions
  • Slit-lamp examination (key eye test)
  • Tear film tests (dry eye assessment)
    • Tear breakup time (TBUT)
    • Schirmer test (tear production)
    • Ocular surface staining (fluorescein dye)

Cause

  • Bacterial infection (can affect any sex, however tends to occur more in females) due to:
    • Hormonal changes
    • Eye makeup use
  • Seborrheic dermatitis (itchy rash on the skin like dandruff)
  • Rosacea (red and blotchy skin)
  • NGLY1 deficiency

Syndromes

Medication

  • Contraceptive
  • HRT
  • Oestrogens supplements

Symptoms

(Tends to be worse at morning)

  • Both eyes affected?
  • Burning soreness or stinging in eyes?
  • Sensitivity to light?
  • Crusty eyelashes?
  • Grit in eyes?
  • Itchy eyes?
  • Loss of vision?
  • Abnormal eyelash growth?
  • Loss of eyelashes?
  • Sticky discharge causing the eyes to stick together?

Complications /Information to beware of/General tips:

This condition can lead to:

Hygiene measures for the management of blepharitis

  • Eye-lid cleansing with a clot or cotton bud soaked in a cleanser (solution of sodium bicarbonate or manufactured lid cleansing product) softly moved across the lid margins, twice a day and then daily once symptoms improve;
  • Warm compresses (40°C) for five minutes twice daily followed by lid massage assist in mobilising meibum;
  • Dry eye may be treated with topical lubricants and any underlying condition, such as eczema or rosacea, should be treated as per standard treatment pathways;
  • Patients should avoid eye makeup application on the lid margin especially eye-liner and mascara.

Blepharitis. BMJ Best Practice. November 2024. Accessed February 2025. https://bestpractice.bmj.com/topics/en-gb/574

Blepharitis. National Institute for Health and Care Excellence. 2023. Accessed February 2025. https://cks.nice.org.uk/topics/blepharitis

Blepharitis (lid margin disease) . The College of Optometrists. 2024. Accessed February 2025. https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/blepharitis_lidmargindisease

Extra measures

  • Baby shampoo maybe considered for short term use (i.e. up to one month) and one needs to see it does help or not, if not consider the treatments above.
  • Don’t share towels, pillowcases, or eye makeup
  • Wash hands regularly, especially after touching eyes
  • Clean eyelids as advised (lid hygiene)
  • Replace eye makeup if infection is active
  • Avoid rubbing eyes and then touching others’ eyes

Eye test and Driving Authority

Persons over 40 years should have eye test at least every 2 years. and you must tell your drivers authority if it affects your driving.

This condition may show similar symptoms to:

Please see your Optometrist

Detailed Information

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References

The Pharmaceutical Journal, PJ, February 2025, Vol 314, No 7994;314(7994)::DOI:10.1211/PJ.2025.1.346170

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