Blepharitis (Sore Eyelids)

Blepharitis is inflammation of the eyelid margins (the edges of the eyelids, where the lashes grow) [1][2]. It usually affects both eyes and tends to come and go for years.

There are two main types, and many people have both [2][4]:

• Anterior blepharitis (front of the lid, at the base of the lashes): crusts and flakes on the lashes. It is linked with staph bacteria that normally live on the skin, dandruff-like skin (seborrhoeic dermatitis), and tiny mites called Demodex.
• Posterior blepharitis, or meibomian gland dysfunction (MGD): the tiny oil glands along the lid edge get blocked or make thick, poor-quality oil. The tears then dry out too fast.

Image to add

Close-up drawing of an eyelid edge with red, swollen margins and small crusts at the base of the eyelashes. Alt text: "Drawing of an eyelid with a red, swollen edge and crusts on the eyelashes, which is blepharitis."

Am I at risk?

Blepharitis is more common if you have [1][2]:

• dry eyes
• rosacea (redness and spots on the cheeks and nose)
• seborrhoeic dermatitis or dandruff
• had styes or chalazion before

Common signs include [1][3]:

• Sore, gritty, burning or itchy eyes
• Red, swollen eyelid edges
• Crusts or flakes on the lashes, often worse in the morning
• Eyelids sticking together when you wake up
• Watery eyes, or eyes that feel dry
• Vision that is a little blurry but clears when you blink
• In long-standing cases, lashes that fall out or grow in the wrong direction

Blepharitis can also lead to styes and chalazion (lumps on the eyelid).

Blepharitis is usually controlled, not cured. Daily lid hygiene is the most important treatment, and it works best when done every day, even when your eyes feel fine [1][4].

Daily lid hygiene (1 to 2 times a day):

1. Warm compress: hold a clean, warm (not hot) cloth or eye mask on your closed eyes for 5 to 10 minutes. This softens the crusts and melts the thick oil in the glands.
2. Gentle massage: with your eyes closed, gently roll your fingertip along the lid edges, towards the lashes, to help the oil flow out.
3. Clean the lid edges: use a cotton bud or clean cloth dipped in cooled boiled water with a few drops of baby shampoo, or ready-made lid wipes from the pharmacy. Gently wipe along the base of the lashes.

Other treatments that may help [1][4]:

• Lubricating eye drops (artificial tears) for dryness and grittiness.
• Antibiotic ointment on the lid edges, given by your doctor.
• For severe MGD or rosacea, your doctor may give antibiotic tablets such as doxycycline or azithromycin for a few weeks. (Doxycycline is not suitable in pregnancy or for young children.)
• Treating dandruff or rosacea can also help your eyelids.

It can take a few weeks to feel better. If you stop lid hygiene, the symptoms often come back.

Blepharitis itself is not an emergency. But some symptoms are not blepharitis and need checking quickly.

• Keep up daily lid hygiene, even when your eyes feel better.
• Avoid eye makeup during flare-ups, especially eyeliner along the lid edge. Remove all makeup fully before sleeping.
• Do not rub your eyes.
• If you wear contact lenses, you may need to wear them less during flare-ups.
• Treat dry eyes, dandruff and rosacea if you have them.

See an eye doctor if your symptoms do not improve after a few weeks of lid hygiene, or if you keep getting styes or lumps on the eyelid.

Where to get help in Brunei

You can walk in to any Community Eye Clinic at your health centre. No referral is needed.