Symptoms and Signs of Eyelid Inflammation (Blepharitis)

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 8/30/2021

Doctor's Notes on Eyelid Inflammation (Blepharitis)

Blepharitis is an inflammation and irritation of the eyelids, which causes redness and swelling. Causes of blepharitis range from allergies and infections to irritation, as well as skin cancers.

Symptoms of blepharitis include

  • eye itching,
  • irritation,
  • burning,
  • dry eyes,
  • increased tearing, and
  • the sensation of “something in the eye."

Contact lens wearers may feel their lenses are irritating and they cannot wear them for long periods. Other symptoms include

  • eyelid redness and non-healing ulcers that may bleed.
  • Vision problems may result from problems tearing.
  • In advanced cases there may be eyelid redness, warmth, and swelling. 

In infectious blepharitis yellow- or green-colored fluid/discharge may cause sticking of the eyelids, especially in the morning. With the most common seborrheic form of blepharitis, dry, flaky patches of skin may develop. In some cases, blepharitis may localize in the skin of the eyelids causing a sty or a chalazion.

  • In allergic blepharitis, the lids may appear dark like raccoon eyes. 

What is the Treatment for Eyelid Inflammation (Blepharitis)?

The main treatment for blepharitis is basic eyelid hygiene. This is not necessarily a cure, but it manages the condition. 

Basic eyelid hygiene includes the following steps:

  1. Apply heat to warm the eyelid secretions to help encourage cleansing and drainage of the secretory passages. 
    • Patients may use a soaked warm towel applied to the lids. 
  2. Wash the eyelid gently (do not scrub) with a warm washcloth, cotton swabs, or gauze pads to remove any crusting, dead skin flakes, or 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 bacitracin, polymyxin B, erythromycin, or sulfacetamide to the eyelid margin after it has been soaked and cleansed. 

Cases that do not respond to basic eyelid hygiene may require medical treatment, which can include: 

  • Oral antibiotics, such as tetracycline, doxycycline, and minocycline 
  • If there are tear duct problems, the use of artificial tears, tear ointments, and closure of the puncta may be advised
  • If there are associated viral or bacterial infections, such as herpes simplex, varicella-zoster, or staphylococcal skin disease, this may require use of antivirals or different antibiotics
  • Seborrhea of the eyelids may be treated with shampoos with selenium
  • Allergic dermatitis may be treated with topical corticosteroids or pimecrolimus (Elidel
  • Conjunctivitis and keratitis can be a complication of blepharitis and antibiotic-corticosteroid solutions and drops may be indicated

In some cases, such as chalazion formation, trichiasis, ectropion, entropion, or corneal disease, surgery may be indicated.

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.