By: Roger M. Kaldawy, M.D.

Milford Franklin Eye Center

  Eyelid margin disease including blepharitis occurs when the eyelids become coated with oily particles and bacteria near the base of the eyelashes. This condition is very common and unfortunately, is often misdiagnosed by many eye professionals as allergy, which it is not. 

With eyelid margin disease the eyelids are inflamed. Symptoms include: Eye and eyelid irritation, a film in the eye, itchiness of the eye, redness of the eye and a burning sensation. 

This condition frequently occurs in people who have a tendency toward oily skin, dandruff or dry eyes. With blepharitis, both the upper and lower eyelids become coated with oily particles and bacteria near the base of the eyelashes. It may cause irritation, itchiness, redness, and stinging or burning of the eye. 

 What causes blepharitis? 

Everyone has bacteria on the surface of their skin, but sometimes bacteria thrive in the skin at the base of the eyelashes. Large amounts of bacteria around the eyelashes can cause dandruff-like scales and particles to form along the lashes and eyelid margins.  

Blepharitis is also associated with meibomianitis— a dysfunction and inflammation of the nearby oil glands of the eyelids (called meibomian glands). Blepharitis is also common in association with a skin disorder called rosacea.  In this case, we call the eyelid problem “ocular rosacea”. 

 What is ocular rosacea? 

People who have acne rosacea, a common skin condition causing pimple-like bumps and facial redness may suffer from ocular rosacea.  This can affect the eyelids with redness and swelling. If you have ocular rosacea, reduce alcohol, caffeine and chocolate in your diet.  Omega-3 fatty acids (fish oil and flaxseed oil) are also helpful. Doxycycline or similar derivatives can help improve the dysfunctional oil glands as well as both facial and eye symptoms. Reducing stress and better sleep are critical in controlling the symptoms. 

What is demodex blepharitis?

Some people with oily (seborrheic) skin, and more so those who have a weakened immune system can have microscopic mites (demodex folliculorum) and their waste materials cause clogging of follicles at roots of eyelashes, and in some cases might be associated with development of skin conditions such as rosacea and blepharitis. Another version of these mites (demodex brevis) can be found more generally in oil glands of the skin and eyelids, which also may contribute to blepharitis symptoms. While presence of these tiny mites is common in everyone, researchers speculate that some people develop demodex blepharitis due to unusual allergic or immune system reactions leading to inflammation.

What if I get a stye? 

A stye develops from an eyelash follicle or an eyelid oil gland that becomes clogged from excess oil, debris or bacteria. Styes can be a complication of blepharitis.  If you have a stye, treat it like you treat blepharitis, and if not better within two weeks, see your ophthalmologist. 

 How is blepharitis treated? 

Blepharitis is often a chronic condition, but it can be controlled with the following treatment: 

Warm compresses. Wet a clean washcloth with warm water, wring it out and place it over your closed eyelids for at least one minute. Repeat two or three times, rewetting the washcloth as it cools. This will loosen scales and debris around your eyelashes. It also helps dilute oil secretions from nearby oil glands, preventing the development of a chalazion (stye)-an enlarged lump caused by clogged oil secretions in the eyelid. 

Eyelid scrubs. Using a clean washcloth, cotton swab or commercial lint-free pad soaked in warm water and few drops of baby shampoo, gently scrub the base of your eyelashes for about 15 seconds per eyelid. 

Antibiotic ointment. Your ophthalmologist may prescribe an antibiotic ointment. Using a clean fingertip or cotton swab, gently apply a small amount at the base of the eyelashes before bedtime. 

Artificial tears or steroid eye drops may also be prescribed temporarily to relieve dry eye or inflammation. 

Specific treatment of demodex blepharitis:  A commercial eyelid scrub combined with tea tree oil may be effective for treating this type of blepharitis.  Shampooing with a product containing a tea tree extract is also helpful. This is available as Tea Tree Shampoo. The target here is to reduce the population of the mite (demodex).  Washing sheets and pillow cases in hot water and drying with the “high” dryer setting is helpful.  Avoid makeup for at least 1 week and discard all old makeup. Other reported treatments of demodex blepharitis include sulfur oil and steroids. An anti-parasitic gel (metronidazole) also has shown effectiveness as a treatment. Hypochlorus acid which is available commercially as a spray is also a helpful cleaning solution to kill demodex  and tends to be less irritating then tea tree oil.

Eyelid margin disease is very common…With a full-time external disease specialist on staff, 4 locations including a surgery center in Milford, our eye centers offer state-of-the art equipment to diagnose and treat eye problems, including blepharitis.  We have published research papers and lectured to other physicians on the subject.  We are now a referral center for difficult cases of ocular surface, lid disease, blepharitis and ocular rosacea. With our expanding practice of 8 providers we can help you manage this problem and continue our mission to provide world class eye care for the entire family. 

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