Blepharitis
Also known as Eyelid Inflammation, Eyelid Margin Disease, Anterior Blepharitis, Posterior Blepharitis, Demodex Blepharitis, Meibomian Gland Dysfunction
Bottom Line
Blepharitis is long-term swelling and irritation along the edge of your eyelids. It can make eyes red, itchy, and crusty, but warm compresses, lid cleaning, and sometimes drops or pills usually keep it under control.
Blepharitis is one of the most common eye problems doctors see. Eye care clinics find signs of it in a large share of adult patients, and it gets more common with age 1.
The eyelid edges hold the roots of the lashes and tiny oil glands called meibomian glands. In blepharitis, this area gets red and swollen. Skin flakes, oil, bacteria, or a tiny mite called Demodex can build up at the base of the lashes. The oil glands can also get blocked, so tears dry up too fast 2.
Blepharitis is not contagious and rarely hurts vision. But it is long-lasting. Most people need to clean their lids and use warm compresses for life, the way you brush your teeth every day. Some people also need medicated drops, ointments, or pills 3.
Symptoms & Warning Signs
Common symptoms of blepharitis are:
- Red, swollen, or itchy eyelid edges
- Crusty or sticky eyelids — often worse when you wake up
- Flakes, dandruff, or oily build-up around the base of the lashes
- Burning, gritty, or dry eyes
- Watery eyes — your eyes make reflex tears when the surface is irritated
- Blurry vision that clears when you blink
- Sensitivity to light
- Repeat styes or small lid bumps (chalazia)
- Missing, broken, or misdirected lashes in long-standing cases
Blepharitis is long-lasting and tends to come and go. It is not contagious and most people do not lose vision from it 3.
- Sudden severe eye pain or any sudden loss of vision
- A chemical splash in the eye or an eye injury
- A red, swollen eye in a baby less than 28 days old
- A red, painful eye in a contact lens wearer (can be a cornea infection)
- Eyelid swelling with fever, pain when moving the eye, double vision, or an eye that looks pushed forward (signs of cellulitis behind the eye)
Types and Causes
Doctors split blepharitis into two main types based on where the trouble is 2:
- Anterior blepharitis. The front of the lid, where the lashes grow, is red and crusty. Usually caused by skin flakes (seborrhea), staph bacteria, or the tiny Demodex mite.
- Posterior blepharitis. The oil glands inside the lid (meibomian glands) are blocked. Tears dry up too fast and the eye feels gritty. This is called meibomian gland dysfunction.
Most people have a mix of both.
Common causes and triggers:
- Seborrheic dermatitis — the same flaky skin that causes dandruff on the scalp.
- Staph bacteria — normal skin germs that overgrow at the lash base.
- Demodex mites — tiny mites that live in lash follicles. They are more common with age. The classic sign is cylinder-shaped collarettes around the lash base 5.
- Rosacea — facial redness, flushing, and bumps that also affect the eyelids. Many adults with rosacea have eyelid involvement 4.
- Allergies and irritants — eye drops, makeup, lash glue, or lash extensions.
Things that raise your risk:
- Older age — Demodex and gland blockage get more common over time
- Rosacea, eczema, or psoriasis
- Dandruff or oily skin
- Daily eye makeup, eyeliner on the inner lid, or lash extensions
- Contact lens wear
- Dry eye disease
Treatment
Blepharitis is long-lasting, so treatment is about daily care plus extra steps when flare-ups happen 3.
Daily lid hygiene (everyone with blepharitis):
- Warm compresses — a clean, warm washcloth on closed eyelids for 5-10 minutes once or twice a day. This softens the oil in blocked glands.
- Lid scrubs — gentle cleaning of the lash base with diluted baby shampoo, store-bought lid wipes, or a hypochlorous acid spray.
- Take off eye makeup before bed and replace mascara every 3 months.
For Demodex blepharitis (cylinder collarettes around lashes):
- Tea tree oil lid scrubs — kill the mite. Use dilute, eyelid-safe products only; never apply pure tea tree oil to skin or eyes 6.
- Lotilaner eye drops (Xdemvy) — a prescription drop made just for Demodex blepharitis. In studies, it cleared collarettes in most patients after 6 weeks 7.
For posterior blepharitis / meibomian gland dysfunction:
- Warm compresses and gland expression — gently massaging the lids after a warm compress can push out blocked oil.
- In-office treatments — heat-and-pressure devices (LipiFlow, iLux, TearCare) and intense pulsed light (IPL) can open blocked glands in moderate to severe cases 8.
- Omega-3 fats — fish or flaxseed in the diet may help; studies show mixed results.
When extra medicine is needed:
- Antibiotic ointment or drops (erythromycin, bacitracin, azithromycin) — short courses for flare-ups.
- Steroid drops — short courses to calm bad flares. Only with an eye doctor's care, since long-term steroids can raise eye pressure.
- Oral antibiotics — low-dose doxycycline is often used for rosacea-linked blepharitis. It changes how the oil glands work, not just kills bacteria 9.
Common Questions About Blepharitis
Next Steps
- 1Start a daily warm compress on closed eyelids for 5-10 minutes, even on good days.
- 2Clean the base of your lashes with a gentle lid scrub or hypochlorous acid spray every day.
- 3Take off all eye makeup before bed and replace mascara every 3 months.
- 4Book an eye exam if your eyelids stay red, itchy, or crusty after 4-6 weeks of home care.
- 5Tell your doctor if you have rosacea, dandruff, or get styes over and over again.
- 6Go to the emergency room for sudden vision loss, severe eye pain, a chemical splash, a red eye in a newborn, a red painful eye in a contact lens wearer, or eyelid swelling with fever.
Find specialists for Blepharitis
Board-certified ophthalmologists who treat Blepharitis.
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