What Is the Main Cause of Blepharitis?

Eyelid redness can be a sign of blepharitis.

Blepharitis is inflammation of the eyelids. Blepharitis may be associated with certain diseases, such as rosacea, hypersensitivity reactions, and seborrheic dermatitis, as well as eye diseases such as dry eye syndromes, small lumps on the eyelid (chalazions), eyelashes that grow abnormally inward (trichiasis), lower eyelid sagging or folding inward (ectropion or entropion, respectively), infectious or other inflammatory conjunctivitis, and inflammation of the cornea (keratitis).

Symptoms and signs that may accompany eyelid inflammation and swelling may include the following:

• Eye irritation or burning
• Eye itching
• Redness of the eyelids
• Flaking of the lid margins
• Changes in the eyelashes
• Watery eyes/tearing
• Feeling as if something is in the eye
• Crusting and matting of the lashes
• Eye redness
• Sensitivity to light (photophobia)
• Eye pain
• Decreased vision
• Visual fluctuations
• Intolerance to heat, cold, alcohol, and spicy foods

If blepharitis is associated with seborrheic dermatitis, symptoms and signs of itchy and flaky scalp and oily skin may accompany it.

If blepharitis is associated with rosacea, signs and symptoms of a red and swollen nose, facial flushing, broken and distended blood vessels in the face, oily skin, pustules, and food intolerances may accompany it.

Causes of blepharitis may include the following:

• Rosacea
• Viral infections
  • Herpes simplex dermatitis
  • Varicella-zoster dermatitis
  • Molluscum contagiosum
• Dermatitis
  • Allergic or contact dermatitis
  • Seborrheic dermatitis
  • Staphylococcal dermatitis
• Parasitic infections, for example, Demodex and Phthiriasis palpebrarum
• Exposure to chemical fumes, smoke, smog, and other environmental irritants
• Acute blepharitis is commonly due to allergies, drug toxicity, or a chemical reaction

Doctors often diagnose blepharitis with a physical exam so they do not need to perform diagnostic tests. To determine the cause of the condition, they may order certain tests, such as

• eyelid margin cultures,
• transillumination studies of the meibomian glands,
• digital-imaging techniques,
• conjunctival impression cytology,
• marginal biopsies,
• analysis of gland secretions, and
• testing for tear insufficiency or nasolacrimal drainage problems.

The main treatment for blepharitis is a program of eyelid hygiene. This is not necessarily a cure, but rather, management of the condition. Basic eyelid hygiene includes three steps:

1. Apply heat to warm the eyelid gland secretions to help encourage cleansing and drainage of the secretory passages. Patients may use soaked warm compresses applied to the lids.
2. Wash the eyelid gently (do not scrub vigorously) with a warm washcloth, cotton swabs, or gauze pads to remove any material in the area such as crusting, dead skin flakes, and loosened keratin. Use normal saline or boiled then cooled distilled water. Cleansing preparations are also available, such as Ocusoft, lavender scrubs (Oasis), and hypochlorous acid (Avenova).
3. Apply an antibiotic ointment such as include bacitracin, polymyxin B, erythromycin, or sulfacetamide to the eyelid margin after soaking and cleansing it.

Cases that do not respond to basic eyelid hygiene may require medical treatment. This can include the following:

• Oral antibiotics, such as tetracycline, doxycycline, and minocycline
• If there is tear film dysfunction, the use of artificial tears, tear ointments, and closure of the puncta may help.
• If there are associated viral or bacterial conditions, such as herpes simplex, varicella-zoster, or staphylococcal skin disease, this may warrant antivirals or different antibiotics.
• Shampoos with selenium may treat seborrheic disease.
• Topical corticosteroids or pimecrolimus (Elidel) may treat allergic dermatitis.
• Conjunctivitis and keratitis can be a complication of blepharitis, and it may be necessary to use antibiotic-corticosteroid solutions and drops.

In some cases, such as such as chalazion formation, trichiasis, ectropion, entropion, or corneal disease, it may be necessary to perform surgery.

Complications of blepharitis include inflammation of the conjunctiva (conjunctivitis, also called pinkeye) and inflammation of the cornea (keratitis).

Recurrent bouts of blepharitis can cause inflammation and scarring that may result in abnormal eyelid position.

It's possible to prevent blepharitis with a consistent regimen of basic eyelid hygiene to prevent outbreaks.