Treating blepharitis | Top Doctors (2024)

Blepharitis is inflammation of the eyelids. The condition may cause symptoms of burning, itching, soreness, watering and redness of the lids and the eyes. Blepharitis is very common and tends to affect people more as they get older although it can affect any age group. If left untreated, it can lead to long term changes causing dry eye and vision loss in a small number of patients.

Here, esteemed consultant plastic surgeon,Mr Sam Orkar,explains why it is better to treat blepharitis as early as possible and how you can self-manage the condition.

What can trigger blepharitis? Can stress be a trigger too?

Some people can be genetically predisposed to blepharitis. In some cases, there are possible environmental factors that could trigger a flare-up such as age, diet and certain skin conditions like rosacea. We don’t fully understand why some people get blepharitis and others do not.

In my experience, certain foods may trigger blepharitis. These include processed or fried foods, sugar, white flour and fizzy drinks tends to aggravate the condition. I have also found that a varied diet with plenty of fruits, vegetables and high intake of natural Omega-3 containing foods helps reduce flare-ups.

Contact lens-wear can also make it worse so it is recommended to hold-off wearing them until it clears up. Whilst there is no evidence to prove that stress is a trigger, we know that stress can deplete vitamins and alter metabolic pathways in the body and can possibly play a role for some people who are more susceptible to stress.

Can blepharitis clear up by itself?

Yes, it can settle on its own. You can get periods where patients with blepharitis turn up with symptoms but they wax and wane. Sometimes it does clear up by itself but most people do require some kind of treatment.

Why is addressing blepharitis important for eye health?

Firstly, the symptoms are troubling for patients and the condition interferes with daily life. If you are planning on having any kind of eye surgery, the treatment of blepharitis is really important as it reduces the risk of infection and inflammation after surgery. Finally, a small proportion of patients with long-term blepharitis can lose their vision due to complications of blepharitis but this is rare.

Some patients can go for decades without properly addressing their blepharitis, which can be disabling to live with but yet they don’t know that it can be treated. Leaving it for such a long time can cause scarring changes that are unable to be reversed.

Is the condition usually temporary or long-lasting and is it likely to recur?

Blepharitis is often a long-term condition which tends to cause persistent symptoms in the background with more severe flare-ups intermittently.

Is it contagious?

Blepharitis is not infectious and therefore it cannot be spread.

How can I manage blepharitis?

You can use warm compresses on the eyelids through the use of an ‘eye bag’ that you can buy over-the-counter, which you warm up in a microwave. It provides soothing relief to the eyelids. This can be followed up by massaging the eyelids with your fingertips.

Finally, clean the lid margins with medicated ‘lid wipes’ to help with removing the crusting that builds up on eyelashes that exacerbate symptoms. You should also use preservative-free lubricating eye drops. Treatment often takes several weeks to have an effect.

How does an eye specialist treat blepharitis?

The specialist will undertake a complete assessment of the individual to determine the level of treatment needed and to exclude the sight-threatening signs of blepharitis.

Initial treatment is as explained above but if this is not adequate, they can prescribe a variety of anti-inflammatory eye drops and medications. They will also look for underlying problems that might need systemic treatments with tablets.

Initially, until you get on top of the problem, you should see your ophthalmologist quite frequently, such as once every few weeks. Once the blepharitis is better controlled, you should see your eye specialist once every six months or so. This is usually enough to make sure it’s not causing any ongoing problems. Many patients can be discharged and won’t need lifelong follow-ups, as long as their blepharitis is not causing any symptoms affecting the quality of life or there are no signs of sight-threatening problems.

What could happen if blepharitis is left untreated?

The majority of untreated patients with blepharitis experience symptoms of burning, watering redness, itchiness and soreness of their eyes. Over time, patients may become tolerant of these symptoms and adapt their lifestyle to accommodate their symptoms.

A small proportion of patients with blepharitis develop sight-threatening complications. These are often driven by exaggerated inflammation which is the body’s response to long term blepharitis. This exaggerated inflammation can cause damage to the ocular surface that can predispose to infection and vision loss.

A larger proportion of patients develop dysfunction of oil glands (Meibomian glands) that are found in the eyelids and which produce oils that help to lubricate the surface of the eye and prevent tear evaporation. Long-term Meibomian gland dysfunction can lead to loss of function of these glands leading to long-term dry eye.