Blepharitis is chronic inflammation of the eyelid margins, linked to meibomian gland dysfunction, staphylococcal bacteria, rosacea or seborrheic dermatitis. It is common, tends to flare and settle, and is controlled rather than cured.
Key symptoms
- Red, itchy or burning eyelids
- Crusts on the lashes, worse in the morning
- Gritty or dry eye feeling
- Watery eyes and mild light sensitivity
What you find on exam
- Red, thickened lid margins
- Scales or collars around the base of the lashes
- Plugged, capped meibomian gland openings
- Lost or misdirected lashes; look for rosacea on the face
- Normal vision and clear cornea
Tests
- Diagnosis is clinical with a penlight or slit lamp
- Culture only if severe or not responding
- Biopsy if one-sided with lash loss and no response (rule out eyelid cancer)
Treatment basics
- Warm compresses for 5 to 10 minutes daily
- Lid hygiene: gentle scrubs with diluted baby shampoo or lid wipes
- Artificial tears for dryness
- Topical erythromycin or bacitracin ointment for flares
- Oral doxycycline for meibomian gland disease or rosacea
Red flags
- Eye pain, reduced vision or strong light sensitivity (corneal involvement)
- Spreading redness and swelling of the lids (cellulitis)
- One-sided disease with lash loss that does not respond
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.