Diagnosis

Tests and procedures used to diagnose blepharitis include:

  • Examining your eyelids. Your doctor will carefully examine your eyelids and your eyes. He or she may use a special magnifying instrument during the examination.
  • Swabbing skin for testing. In certain cases, your doctor may use a swab to collect a sample of the oil or crust that forms on your eyelid. This sample can be analyzed for bacteria, fungi or evidence of an allergy.

Treatment

Self-care measures, such as washing your eyes and using warm compresses, may be the only treatment necessary for most cases of blepharitis. If that is not enough, your doctor may suggest prescription treatments, including:

  • Medications that fight infection. Antibiotics applied to the eyelid have been shown to provide relief of symptoms and resolve bacterial infection of the eyelids. These are available in a variety of forms, including eyedrops, creams and ointments. If you don't respond to topical antibiotics, your doctor may suggest an oral antibiotic.
  • Medications to control inflammation. Steroid eyedrops or ointments may help control inflammation. Your doctor may prescribe both antibiotic and anti-inflammatory drugs.
  • Medications that affect the immune system. Topical cyclosporine (Restasis) is a calcineurin inhibitor that has been shown to offer relief of some signs and symptoms of blepharitis.
  • Treatments for underlying conditions. Blepharitis caused by seborrheic dermatitis, rosacea or other diseases may be controlled by treating the underlying disease.

Blepharitis rarely disappears completely. Even with successful treatment, the condition frequently is chronic and requires daily attention with eyelid scrubs. If you don't respond to treatment, or if you've also lost eyelashes or only one eye is affected, the condition could be caused by a localized eyelid cancer.

Lifestyle and home remedies

Self-care measures such as the following may be the only treatment necessary for most cases of blepharitis.

Clean your eyes daily

If you have blepharitis, follow this self-care remedy two to four times a day during flare-ups and once or twice a day after the condition is under control:

  • Apply a warm compress over your closed eye for several minutes to loosen the crusty deposits on your eyelids.
  • Immediately afterward, use a washcloth moistened with warm water and a few drops of diluted baby shampoo to wash away any oily debris or scales at the base of your eyelashes. Use a different clean cloth for each eye.
  • In some cases, you may need to be more deliberate about cleaning the edge of your eyelids where your eyelashes are located. To do this, gently pull your eyelid away from your eye and use the washcloth to gently rub the base of the lashes. This helps avoid damaging your cornea with the washcloth. Ask your doctor whether you should use a topical antibiotic ointment after cleaning your eyelids in this way.
  • Rinse your eyelids with warm water and gently pat it dry with a clean, dry towel.

It also may be a good idea to stop using eye makeup when your eyelids are inflamed. Makeup can make it harder to keep your eyelids clean and free of debris. Also, it's possible that makeup could reintroduce bacteria to the area or cause an allergic reaction.

Lubricate your eyes

Try over-the-counter artificial tears. These lubricating eyedrops may help relieve dry eyes.

Control dandruff and mites

If you have dandruff that's contributing to your blepharitis, ask your doctor to recommend a dandruff shampoo. Using a dandruff-controlling shampoo may relieve your blepharitis signs and symptoms. Using tea tree shampoo on your eyelids each day may help deal with mites. Or try gently scrubbing your lids once a week with a 50 percent tea tree oil, which is available over-the-counter.

Alternative medicine

No alternative medicine treatments have been found to conclusively ease the symptoms of blepharitis. However, a diet rich in omega-3 fatty acids or supplements containing omega-3 fatty acids may be helpful for blepharitis associated with rosacea. Omega-3 fatty acids are found in foods such as salmon, tuna, trout, flaxseed and walnuts.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. If your doctor suspects you may have an eyelid problem, such as blepharitis, you may be referred to an eye specialist (optometrist or ophthalmologist).

Because appointments can be brief, it's a good idea to be prepared for your appointment. Here's some information to help you get ready.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if you need to do anything in advance, such as remove your contact lenses.
  • List any symptoms you're experiencing, including any that may seem unrelated to blepharitis.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • List questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. List your questions from most important to least important in case time runs out. For blepharitis, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • What are other possible causes for these symptoms?
  • Are there general medical disorders that can cause this problem?
  • What kinds of tests will I need?
  • What treatments are available, and which do you think would be the best treatment for me?
  • Is this condition usually temporary or long lasting? After treatment, will it come back again?
  • Is my blepharitis contagious?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • Do you have any brochures or other printed material that I can take with me?
  • What websites do you recommend visiting for more information?
  • Can I continue to wear contact lenses?
  • Do I need to take special care cleaning my contact lenses and my carrying case?
  • Will I need a follow-up visit? If so, when?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first notice your symptoms?
  • Do your symptoms come and go, or do you always have them?
  • Do your symptoms occur at a particular time of day?
  • Have you been wearing contact lenses?
  • Have you changed cosmetic brands recently?
  • Have you changed soap or shampoo brands recently?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Has anyone close to you had a recent eye infection?
  • Have you ever had any eye diseases, eye surgeries or eye injuries?
  • Do you have other diseases or conditions?

What you can do in the meantime

As you wait for your appointment, you may find some relief from eye irritation by gently washing your eyelids a few times each day. To wash your eyelids:

  • Apply a warm washcloth to your closed eyelids for up to five minutes.
  • Gently rub your closed eyelids with a diluted solution of baby shampoo. Use a clean washcloth or clean fingers. You may need to hold the lid away from the eye while you are using the wash cloth to rub along the lash margin. This may require several minutes of gentle rubbing to remove the scales.
  • Rinse your eyes thoroughly with warm water.

Avoid anything that irritates your eyes, such as eye makeup and contact lenses.

March 13, 2015
References
  1. Preferred Practice Pattern Guidelines. Blepharitis — 2013. San Francisco, Calif.: American Academy of Ophthalmology. http://one.aao.org/preferred-practice-pattern/blepharitis-ppp--2013. Accessed Feb. 6, 2015.
  2. Shtein RM. Blepharitis. http://www.uptodate.com/home. Accessed Feb. 6, 2015.
  3. Facts about blepharitis. National Eye Institute. http://www.nei.nih.gov/health/blepharitis/blepharitis.asp. Accessed Feb. 6, 2015.
  4. Blepharitis. American Optometric Association. http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/blepharitis?sso=y. Accessed Feb. 6, 2015.
  5. AskMayoExpert. Blepharitis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  6. Lindsley K, et al. Interventions for chronic blepharitis. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005556.pub2/abstract. Accessed Feb. 6, 2015.
  7. Barbara Woodward Lips Patient Education Center. Inflamed eyelid (blepharitis). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  8. Ferri FF. Blepharitis. In: Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Feb. 6, 2015.
  9. Pflugfelder SC, et al. Treatment of blepharitis: Recent clinical trials. Ocular Surface. 2014;12:273.
  10. Sadarangani SP, et al. Non-anti-infective effects of antimicrobials and their clinical applications: A review. Mayo Clinic Proceedings. 2015;90:109.
  11. Yanoff M, ed., et al. Blepharitis. In: Ophthalmology. 4th ed. Edinburgh, U.K.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Feb. 6, 2015.
  12. Alpha-linolenic acid. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Feb. 9, 2015.
  13. Robertson DM (expert opinion). Mayo Clinic, Rochester, Minn., Feb. 20, 2015.