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Eyelid Inflammation (Blepharitis)

What Is Blepharitis (Eyelid Inflammation)?

Blepharitis (BLEH-fuh-REYE-tis) is a chronic irritation of the eyelids, which causes redness and matting of the eyelids. It has a variety of causes, ranging from allergy and infection to irritation, as well as skin cancers. It is the most common eye disease.

Usually, blepharitis is mainly a nuisance and responds well to treatment.

What Are Causes of Blepharitis?

Blepharitis may be caused by inflammation, bacteria, allergies, tumors, environmental conditions, trauma such as rubbing the lids, tear film irregularities, or it may be related to systemic disease.

  • Inflammatory or allergic blepharitis results in increased shedding of skin cells near the eyelids.
  • Allergic blepharitis may be caused by irritants in the atmosphere (for example, chemicals at work) or by many medications, either ocular or systemic. In many people, blepharitis is caused by exposure to animals such as a dog or cat.
  • The ulcerative form (infectious blepharitis) often results in an infectious yellowish or greenish discharge.
  • Tear film abnormalities are characterized by abnormal or decreased tears.
  • Blepharitis may be caused by systemic medical conditions or skin cancers of various types.
  • Abnormalities of the eyelids include inturning (entropion) or outturning (ectropion).

What Are Signs and Symptoms of Blepharitis?

Blepharitis usually causes symptoms of eye itching, irritation, burning, increased tearing, and the sensation that something "may be in the eye." The complaint that "my eyes feel dry" is common.

With contact-lens wearers, it is often mentioned that "I can't wear my lenses for as long as I did before" and "the lenses irritate me more."

The lids may be red and may have ulcerative, non-healing areas that may actually bleed.

  • Vision is usually normal, although a poor tear film often blurs vision, causing varying amounts of fluctuating vision during the day.
  • Redness, warmth, and swelling in advanced cases may also be noted.

In allergic blepharitis, the lids may appear dark like raccoon eyes. This is called an "allergic shiner" and is very common in children.

  • Flaking and eyelid matting or "gluing" of the lashes are common.
    • In the infectious form, there may be yellow- or green-colored fluid/discharge, which causes sticking of the lids, especially in the morning.
    • With the most common seborrheic form, dry, flaky patches of skin may develop. Dandruff is common on the scalp and the eyebrows.

Secondarily, the cornea may show tiny erosions or peripheral corneal ulcers.

Blepharitis may localize in the skin of the eyelids causing a sty or a chalazion, which, if it does not respond to medical treatment, may require incision (lancing) for drainage.

Increased tear production is common and may be quite bothersome.

Chronic blepharitis may result in damage of varying severity, including redness, tearing, and matting of the lids. This may have a marked negative effect upon vision and therefore upon the eyeglass prescription. An inflammatory nodule of the lids (a sty) may develop. This is treated with antibiotic drops, hot compresses, or incision.

Use of contact lenses or dry eyes may also cause noninfectious blepharitis. Since there are many germs on the eyelids, antibiotic drops may be used in these conditions, as well.

Last Reviewed 9/11/2017

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Dry eye syndrome (DES) is a common disorder of the tear film, affecting a significant percentage of the population, especially those older than 40 years of age. DES can affect any race and is more common in women than in men.

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