Blepharitis

Blepharitis is a common, long-term inflammation of the eyelid margins. It can affect the skin at the base of the eyelashes and the oil glands within the eyelids (meibomian glands). Blepharitis often causes irritation, redness, crusting and symptoms of dry eye.

While it is rarely serious, blepharitis can be persistent and tends to flare up. With the right routine and treatment plan, symptoms can usually be well controlled.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment to confirm the cause, rule out other conditions, and recommend an effective treatment and eyelid care plan.

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Types of Blepharitis

Blepharitis is often grouped into two main types (many people have a combination of both):

• Anterior blepharitis
  Affects the front edge of the eyelid where the eyelashes attach. It is often linked to skin conditions and bacterial overgrowth.
• Posterior blepharitis (Meibomian Gland Dysfunction)
  Affects the inner eyelid margin and oil glands, leading to poor-quality tears and evaporative dry eye.

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Common Causes of Blepharitis

Blepharitis can be associated with several contributing factors, including:

• Meibomian gland dysfunction (oil glands not producing the right amount/quality of oil)
• Skin conditions, such as eczema, psoriasis or rosacea
• Bacterial overgrowth at the eyelid margin
• Seborrhoeic dermatitis (dandruff-type skin inflammation)
• Allergy and environmental irritation
• In some cases, mites (Demodex) can contribute to persistent eyelid inflammation

Your consultant will assess which factors are most relevant for you, as this guides treatment.

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Symptoms of Blepharitis

Symptoms often affect both eyes and may fluctuate. Common symptoms include:

• Itchy, sore or burning eyelids
• Red, inflamed eyelid margins
• Crusting or flakes at the base of the lashes (especially on waking)
• Watery eyes or excessive tearing
• Dry, gritty or “foreign body” sensation
• Light sensitivity
• Blurred vision that improves with blinking (often related to tear film instability)
• Sticky eyelids in the morning

Blepharitis can also contribute to:

• Styes (hordeolum)
• Chalazion (meibomian cyst)
• Worsening dry eye symptoms

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Diagnosis at Royal Buckinghamshire Hospital

Diagnosis is typically made through a detailed eye assessment, including:

• Consultant-led history and symptom review
• Examination of the eyelids and lashes using a slit-lamp microscope
• Assessment of the tear film and signs of dry eye
• Checking the meibomian glands (oil gland openings) for blockage or thickened oil
• Assessment for associated skin conditions or allergy where relevant

If symptoms are persistent or atypical, your consultant may also consider other causes of red or uncomfortable eyes.

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Treatment & Management

Blepharitis is usually managed with a combination of regular eyelid hygiene and targeted treatments during flare-ups.

Eyelid hygiene routine (core treatment)

A consistent routine is often the most effective long-term approach:

1. Warm compress
   Apply a warm compress to closed eyelids for 5–10 minutes to soften oils and loosen debris.
2. Lid massage
   Gently massage the eyelids (as advised) to help express the oil glands.
3. Lid cleaning
   Clean the eyelid margins to remove crusts and reduce inflammation. This may be done with lid wipes or a recommended cleaning solution.

Your consultant will advise how often to do this based on severity (typically daily, and sometimes twice daily during flare-ups).

Additional treatments (when needed)

Depending on severity and cause, treatment may also include:

• Lubricating eye drops to relieve dry eye symptoms
• Anti-inflammatory eye drops or ointments (short courses under medical guidance)
• Antibiotic ointment/drops if bacterial involvement is suspected
• Oral antibiotics (commonly used for meibomian gland dysfunction or rosacea-related inflammation in selected cases)
• Treatment targeted at Demodex if this is contributing to persistent symptoms
• Advice on reducing triggers (screen breaks, managing allergy, skincare/rosacea management)

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Self-care and prevention

Practical steps that can reduce flare-ups include:

• Avoid rubbing your eyes
• Remove eye makeup thoroughly and avoid eye makeup during flare-ups
• Replace old eye makeup and avoid sharing products
• Use warm compresses and lid hygiene consistently (even when symptoms improve)
• Manage contributing skin conditions (e.g., rosacea) where relevant
• Take regular breaks from screens and consider humidifying dry environments

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If you have ongoing eyelid irritation, recurrent styes, or symptoms of dry eye that are not improving, contact Royal Buckinghamshire Hospital for assessment and a tailored treatment plan. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.