Blepharitis or eyelid inflammation – symptoms and causes

Blepharitis is a chronic inflammation that affects the eyelash edge of the eyelids, which is the boundary between the skin and mucous membrane of the eye (where the eyelashes begin).

Blepharitis occurs when the small sebaceous glands (meibomian glands) located near the lash base do not function properly.
This causes:

  1. inflammation and redness of the eyelids,
  2. swollen eyes, scaling, scab and irritant ulcers.


Types of blepharitis

There are three types of blepharitis, depending on the cause:

  1. Ulcerative blepharitis: The cause is a bacterial infection, usually caused by staphylococcus: the infection can begin in children and persist into old age.
  2. Hyperemic blepharitis: Usually there is no specific cause, the symptoms are swelling and redness of the eyelids and reddened eyes.
  3. Scaly or seborrheic blepharitis: Caused by a condition such as:

It is characterized by an oily secretion and by crusts that dissolve.

Classification of blepharitis based on localization

  1. Anterior or anterior blepharitis, affects the front and outer sides of the eyelid, where the eyelashes attach.
  2. Posterior or posterior blepharitis, associated with a malfunction of the meibomian glands inside the eyelids, which secrete an oily fluid and serve to moisturize the eyes.
  3. Mixed form, often a mixed form at the same time in the front and rear area, but with different degrees of severity.

Symptoms of blepharitis

  • Lacrimation of the eyes
  • Reddened eyes
  • Sensation of burning eyes and foreign bodies
  • Eyelids that appear greased
  • Itching on the eyelids
  • Swollen and reddened eyelids
  • Skin scaling around the eyes
  • Crusting on the eyelashes upon awakening
  • Glued eyelids (especially in the morning)
  • Hypersensitivity to light (photophobia)
  • Abnormal eyelash growth
  • Loss of eyelashes

Anterior blepharitis

Anterior blepharitis can be divided into: staphylococci, seborrheic and dermodex blepharitis, depending on the cause.
Cold does not provoke blepharitis.

The symptoms of staph blepharitis caused by bacteria are often severe and can also lead to eyelash loss.
Conjunctivitis caused by bacteria (a common form of infection on the eyes) can occur along with blepharitis.
In addition to staphylococci, there are other types of bacteria and viruses that can cause anterior blepharitis.

Untreated bacterial blepharitis can cause long-term effects, for example:

  • Ectropion (malposition of the eyelid with outward rotation)
  • Thickened eyelid edges
  • Extended and visible capillaries
  • Trichiasis (eyelash chafing)
  • Entropion (rolling eyelid)

In cases of trichiasis and entropion, the cornea may experience significant erosion by rubbing the eyelashes on the eye.

Seborrheic blepharitis is caused by seborrheic dermatitis, a condition that causes scaling and peeling, including on the eyelids.
The causes of seborrheic dermatitis are not known, but sometimes it occurs in people with weakened immune systems.
Fungi or some yeast species that feed on oils (lipids) in the skin can cause seborrheic dermatitis along with blepharitis.

In blepharitis caused by demodex mites (demodicosis of the eyelashes), the demodex folliculorum mites and their waste products can lead to blockage of the follicles at the roots of the eyelashes and in some cases they can be associated with the development of skin diseases, such as

  • rosacea,
  • Blepharitis.

A cotton swab soaked in tea tree oil, which is used to stroke over the eyelid, may be effective in treating this type of blepharitis.
Other treatments for demodex blepharitis consist in the use of:

  • sulphur oil,
  • Corticosteroids
  • antiparasitic gel (metronidazole).

Another species of mite (Demodex brevis) can generally be found in the sebaceous glands of the skin and eyelids. These mites can contribute to the symptoms of blepharitis.
These tiny mites are present in all humans, but some researchers suspect that some individuals develop demodex blepharitis as an allergic (often to cosmetics) or autoimmune reaction that causes the inflammation.

Posterior blepharitis

Posterior blepharitis (also called meibomian blepharitis or meibomitis) is due to the dysfunction of the meibomian glands that release oil inside the eyelids.
The openings of these glands are located on the inner edge of the eyelid and the oil secreted by the meibomian glands helps to prevent the evaporation of tear fluid.
Meibomian blepharitis decreases leakage from the meibomian glands or causes abnormal oil secretion.
Possible symptoms of posterior blepharitis:

  • Itchy eyelids
  • Inflamed and thickened eyelid edges
  • Incrustations of the eyelids

With this type of blepharitis, the tears may appear frothy.
Meibomian blepharitis is often associated with dry eye syndrome.

Rosacea blepharitis is characterized by:

  • inflammation of the eyelids associated with dysfunction of the sebaceous glands,
  • Dandruff and crust formation.

Acne rosacea is a common inflammation of the skin, characterized by:

  • pimple-like surveys,
  • Redness of the face, especially in the area of the cheeks, forehead, nose and chin.

Rosacea appears to be tied to certain genetic tendencies and environmental factors, such as increased sun exposure.

Herpetic blepharitis is triggered by:

What are the possible complications of blepharitis?

In most cases, blepharitis is uncomfortable, but not serious or dangerous to vision.
Complications are rare. Among them are:

  • Chalazion (meibomian cyst). This disorder is caused by the occlusion of a meibomian gland that swells but does not hurt. Sometimes a chalazion becomes infected and hurts.
  • Hordeolum (stye). This condition is caused by inflammation of the sebaceous glands on the outside of the eyelid.

Changes in eyelashes, only with long-lasting chronic blepharitis. These include:

  • loss of eyelashes (madarosis);
  • eyelash tilt to the eye (trichiasis);
  • depigmentation of eyelashes (poliosis);
  • Ulceration of the eyelids. This can cause a twisting or misalignment of the eyelid inwards towards the eyeball (entropion) or outwards (ectropion);
  • Conjunctivitis (inflammation of the anterior eye area). This can lead to eye pain, redness and lacrimation;
  • Conjunctival blisters. Small, coarse, triangular and white-yellowish nodules (1-3 mm) are formed, surrounded by raised, but small blood vessels.
    The blisters usually form in the lower part of the eye, just below the cornea of the eye.
  • Corneal inflammation (keratitis), ulceration and scarring. This complication is rare, but serious, because it can affect vision.

How is blepharitis diagnosed?

Blepharitis is detected on the basis of a comprehensive eye examination. The examination of the ophthalmologist focuses on:

  1. Clinical history of the patient to determine other conditions that may affect the problem with the eyes.
  2. Examination of the outer eye, including the structure of the eyelids, the texture of the skin and the appearance of the eyelashes.
  3. Evaluation of eyelid edges, eyelash attachment and opening of the meibomian glands at magnification and under bright light.
  4. Evaluation of the quantity and quality of tear fluid.

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