Blepharitis —Causes, Symptoms & Treatment Options

Blepharitis is an inflammation of the eyelids which casues the formation of red, itchy, dandruff-like scales around the eyelashes —the condition is often chronic and becomes more and more difficult to treat as its severity increases.

If you understand blepharitis you can identify and treat it while it’s still in it’s early stages. In this short guide, we are going to talk about its causes, symptoms, and how to treat it.

Causes of Blepharitis

Blepharitis occurs in two forms:

Demodex feeding on the biofilm

Demodex feeding on the biofilm

Anterior blepharitis affects the outside front of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus) and scalp dandruff. Less commonly, allergies or a mite infestation of the eyelashes can cause anterior blepharitis.

Posterior blepharitis affects the inner eyelid (the moist part that makes contact with the eye) and is caused by problems with the oil (meibomian) glands in this part of the eyelid. Two skin disorders can cause this form of blepharitis: acne rosacea, which leads to red and inflamed skin, and scalp dandruff (seborrheic dermatitis).

So, now that we know the causes of blepharitis, how does it occur?

For starters, the inflammation is caused by the overgrowth of bacteria that live at the base of the eyelashes and along the margins of the eyelids. As these bacteria multiply out of control, they produce a biofilm. Over time, the biofilm becomes toxic, and this toxic biofilm is what attracts eyelash mites, known as demodex, which feed on it and multiply, worsening the inflammation of the eyelids.

Meibomian Glands.jpg

While all this is happening, the bacteria in the biofilm produce substances known as exotoxins that cause the inflammation of the oil-secreting glands (also known as meibomian glands) in the eyelids.

The blocking of these oil secreting glands causes a condition known as meibomian gland dysfunction which leads to further eyelid discomfort and dry eyes.

There are a number of symptoms that you will experience as the condition progresses

Symptoms of Blepharitis

blepharitis healthy comparison.jpg
  • Itchy eyelids

  • Burning or stinging eyelids

  • Irritated, watery eyes

  • Crusty debris at the base of the eyelashes

  • Red swollen eyelids

  • Sensitivity to light

  • Loss of eyelashes

  • Lashes that grow irregularly

  • Crushed eyelashes when you wake up

  • Greasy eyelashes

You won’t necessarily have all of these symptoms at once. It all depends with the severity of the condition.

Additionally, blepharitis also causes contact lens discomfort which forces many people to quit using contact lenses.


When you go to your doctor, he or she will determine the cause of your eyelid inflammation and check your eyes to decide what type of blepharitis treatment is best for you. Once the inflammation has been diagnosed, he or she will recommend one of the following treatment procedures:

Eyelid Scrubs

Your doctor will recommend a daily routine of lid scrubs and warm cloth compresses to remove the buildup of biofilm and excess bacteria from the margin of the eyelid. The daily scrubbing will help in clearing dried oils on your eye lids too. This procedure is easy to perform at home.  Eyelid scrubs are widely available over the counter or you can use a wash cloth with baby shampoo.

Health Center Treatments

While eyelid scrubs at home work very well, the condition may be so severe that your doctor recommends professional treatment.

There are other procedures that the doctor can use in the office, which include;

  • Electromechanical lid margin debridement – this procedure is applied to remove biofilm, bacteria, and demodex mites from your eyelids and clear up clogged meibomian glands.

  • Mechanical lid debridement - The doctor will use a small metal spade to scrape the lid margin to remove the buildup of waxy deposits on the lid margins.

Medicated Eye Drops

If the condition had deeply affected your eyes to an extend of causing a pink eye or other eye related infection, the doctor will prescribe medicated eye drops and/or ointments to cure the infections.

If you think you or someone you know needs medical treatment for their blepharitis condition, you can schedule an appointment with one of Midtown Optometry’s expert opticians.

medicated eye drops

Living With Blepharitis

eye cleaning.jpg

Since blepharitis is a chronic disease with a high chance of recurrence , you’ll need to maintain good lid hygiene to clear the bacteria as well as the mites, and lid cleaning must become part of your regular routine.

To begin, wash your hands thoroughly and then dampen a washcloth with warm water (nearly hot).

Close your eyes and then gently place the washcloth on your eyelids for several minutes, the gently rub your eyelid margin with the washcloth adding a small amount of baby shampoo as a detergent — remember to be gentle on your eyes. You can also use specific lid scrubs bought at the store.

A cotton-tipped swab also works well to isolate the lid margin. As you gently apply the solution around the edges of your eyelids both upper and lower, be careful not to let any of the solution get in contact with your eyes.

By maintaining high levels of hygiene, blepharitis will never get beyond control. It doesn’t take long to clean your eyelids. As long as you keep them clean, you’ll avoid this very common problem.

For more tips on how you can maintain proper eyelid hygiene to combat chronic blepharitis, watch this short video


Donations for Fire Fighters in Big Sur

While listening to the radio, Dr Ayesha Burns heard that one of the items the fire fighters in Big Sur needed most was eye wash and lubricating drops.  That day, we contacted our reps at Alcon to coordinate a donation of over 600 bottles of Systane Ultra and Systane Balance artificial tears.  We are excited to be in the unique position to help our community, and our thoughts are with those who have lost their homes and our fire fighters who are working tirelessly to protect further loss.

Donated eye drops from Midtown Optometry

Updated: 11/29/2016

Xiidra Prescription Eyedrops Approved by FDA

Xiidra Dry Eye Drops

Xiidra Dry Eye Drops

Xiidra from Shire Pharmaceuticals is prescriotion eye drop for the treatment of inflammatory dry eye.

Dry eye disease is a condition that affects 10-15 percent of all Americans. The optometry community is excited to have another option for it's treatment.  

Read the FDA statement here.

The effectivy of Xiidra was confirmed in a double blind study of thousands of patients ages 19-97 compared against a placebo treatment.

Xiidra is not yet covered by Medicare or other vision and medical insurances.

How Effective is Xiidra?

In clinical trials, the most common adverse reactions reported in 5-25% of patients were instillation site irritation, dysgeusia and reduced visual acuity. Other adverse reactions reported in 1% to 5% of the patients were blurred vision, conjunctival hyperemia, eye irritation, headache, increased lacrimation, eye discharge, eye discomfort, eye pruritus and sinusitis.

How to Use Xiidra Properly?

The most important step you need to follow is to use Xiidra as your doctor tells you, beyond that here are a couple of tips:

  • Contact lenses should be removed prior to the administration of Xiidra and may be reinserted 15 minutes following administration.

  • Use 1 drop of Xiidra in each eye, 2 times each day, about 12 hours apart.

  • Use Xiidra right away after opening. Throw away the single-use container and any unused solution after you have applied the dose to both eyes. Do not save any unused Xiidra for later.

  • To avoid the potential for eye injury or contamination of the solution, patients should not touch the tip of the single-use container to their eye or to any surface.

For more advice on properly using your Xiidra Prescription you can watch following video or click here to download the “How to Use Xiidra” pdf.


Important Safety Information

Do not use Xiidra if you are allergic to any of its ingredients. Seek medical care immediately if you get any symptoms of an allergic reaction.

The most common side effects of Xiidra include eye irritation, discomfort or blurred vision when the drops are applied to the eyes, and an unusual taste sensation.

It is not known if Xiidra is safe and effective in children under 17 years of age.

For additional safety information, click here for Full Prescribing Information and Patient Information and discuss with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit, or call 1-800-FDA-1088.