Crusty, Itchy Eyelids? How to Fix Blepharitis for Good

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What Is Blepharitis?

Blepharitis is a chronic inflammation of the eyelids, typically affecting the eyelash follicles or meibomian glands (oil-producing glands). It’s a common but often recurring condition that can cause discomfort and irritation.

Key Facts (American Academy of Ophthalmology [AAO]):
✔ Affects 37% of patients visiting eye doctors (NIH study)
✔ Not contagious, but can lead to dry eye, styes, or chalazia
✔ Often chronic (requires long-term management)

Types of Blepharitis (AAO & Mayo Clinic)

  1. Anterior Blepharitis – Affects the eyelash base
    • Staphylococcal (bacterial)
    • Seborrheic (dandruff-like flakes)
  2. Posterior Blepharitis (Meibomian Gland Dysfunction – MGD)
    • Clogged oil glands leading to evaporative dry eye
  3. Mixed Blepharitis – Both anterior and posterior

Symptoms (AAO & NIH)

✔ Red, swollen eyelids
✔ Burning, itching, or gritty sensation
✔ Crusty debris at eyelash bases (worse in the morning)
✔ Flaky skin around eyes (like dandruff)
✔ Watery or dry eyes
✔ Light sensitivity

Not Usually Present: Severe pain or vision loss (may indicate a different condition).

Diagnosis (American Optometric Association [AOA])

  1. Slit-lamp exam – Checks for eyelid inflammation, gland blockage.
  2. Meibomian gland evaluation – Assesses oil secretion quality.
  3. Tear film assessment – Rules out dry eye syndrome.

Treatment (AAO & UpToDate)

1. Daily Eyelid Hygiene (Most Important!)

Warm compresses (5-10 mins, 2x/day)
Lid scrubs (baby shampoo or commercial wipes)
Gentle massage to express oil glands

2. Medical Treatments

  • Artificial tears (for dry eye)
  • Antibiotic ointment (erythromycin/bacitracin)
  • Oral doxycycline (for severe MGD)
  • Steroid drops (short-term for inflammation)

3. Advanced Options

  • Lipiflow (thermal gland treatment)
  • BlephEx (in-office lid cleaning)

Prevention (CDC & AAO)

✔ Daily lid hygiene (even when asymptomatic)
✔ Avoid eye rubbing
✔ Replace eye makeup every 3 months
✔ Treat dandruff/scalp conditions (if seborrheic blepharitis)
✔ Use omega-3 supplements (may improve oil gland function)

Red Flags: When to See a Doctor (Mayo Clinic)

Seek medical care if:

  • Symptoms worsen despite home care
  • Vision becomes blurry
  • Severe pain or swelling develops
  • Recurrent styes/chalazia occur
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