Blepharitis is a chronic inflammation of the eyelids and it is one of the most common problems we see in the office. Patients with blepharitis often complain of itching, burning, a chronic mild foreign body sensation, and mattering on lashes (particularly in the morning).  Patients who also have dry eyes seem to be bothered the most by blepharitis.
There are several causes for blepharitis but by far the most common are Staphylococcal bacterial infection, meibomian gland dysfunction (these glands of the eyelid produce components of the eye’s tear film) and seborrhea.  Staph infection of the eyelid commonly begins in childhood and continues for life.  Bacteria such as staph, like it or not, colonize on our bodies; such colonization on the eyelids can lead to crusty deposits along the lashes, irregularity and redness of the lid margin and a red irritated eye.  It is likely that decreased tear production (dry eye) may predispose individuals to such Staph blepharitis by altering local resistance to such bacteria.  If the lash or lid glands become involved a stye or chalazion (a blocked and enlarged lid gland) may result.  The goal to treatment is to reduce the amount of bacteria on the eyelid margins.
Meibomian gland dysfunction can cause eyelid redness and irritation. The secretions often fill the glands and thicken the eyelid margin.  This is best initially treated with daily warm compresses and gentle lid message to express the material from the glands.  Oral antibiotics can be helpful in severe cases.
Seborrhea is a skin disorder that can affect the eyelids and cause a greasy, waxy, scaling accumulation of skin along the lid margin.  The oil producing glands in the lid are overactive.  Seborrhea can also affect other areas of skin such as the scalp, back, chest and behind the ears.  If the scalp is affected, daily treatment of scalp seborrhea with medicated shampoo may help the eyelids as well.
The initial step in treating all forms of blepharitis is to undertake eyelid hygiene.  Most patients simply apply a warm compress for a few minutes to soften adherent material and/or warm the meibomian secretions, then clean the eyelid margins.  To clean the lid margins, we recommend placing a few drops of baby shampoo into a cup of warm water then use this solution to gently scrub the lashes and eyelid margins with a wash cloth or cotton applicator.  Simply use warm water alone if the shampoo is irritating.  You want to feel the eyelashes moving when you do this (some individuals close their eyes so tight they do not scrub the base of the eye lashes).  We recommend doing this daily for all blepharitis patients.  When the irritation and redness really flare up it is wise to scrub the lids more than once a day. Artificial tears can also provide some comfort, particularly if the eyes are also dry.  Only in recalcitrant cases or severe flare ups are antibiotics needed.  Antibiotic ointments work best as they can be applied to the lashes but occasionally oral antibiotics are needed to treat the eyelid glands.  Rarely a steroid/antibiotic combination ointment can be used to kill the bacteria and provide relief of bothersome symptoms.
Separating these three common forms of blepharitis is sometimes very difficult as they frequently appear together.  The important thing to remember is that all forms of blepharitis can be treated with a brief warm compress and lid scrubs (scrubbing the eyelashes and eyelid margins) every night with warm water or dilute baby shampoo.  The problem is chronic and many patients unfortunately stop their lid scrubs when they feel better only to find they will flare up in a few days.  If you have blepharitis, remember, lid scrubs every night will lead to greater comfort on a daily basis.