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What Are the Causes of Blepharitis? Hero

What Are the Causes of Blepharitis?

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Diagram comparing the symptoms of blepharitis to a normal, healthy eye

Blepharitis is an uncomfortable condition that can affect people in complicated ways. One thing that all blepharitis seems to have in common involves infections surrounding your eyelids, but as to why, how, or when it can develop depends on multiple factors, including skin-health issues.

But your optometrist can locate the problem in a routine eye exam, or even an emergency eye care visit, for patients in pain and distress. Whether through dry eye treatments or vision therapy after emergency eye care, knowing what can be done and how to recover can go a long way. It all starts with learning about blepharitis and its causes!

What is Blepharitis?

Blepharitis is a common eye disease caused by a bacterial infection or skin conditions like scalp dandruff or rosacea. While uncomfortable, It’s not contagious and has no impact on the patient’s total vision. Regardless of type, common symptoms include a burning sensation in the eyes, excessive tearing, itching, red and swollen eyelids, dry eyes, and crusty eyelids

There are two types of blepharitis: anterior and posterior. Anterior blepharitis persists at the eyelids’ outer front edge where the eyelashes are, while posterior blepharitis occurs in the inner edge of the eyelid that’s connected to the eye. Staphylococcal blepharitis and seborrheic blepharitis belong to the anterior variety, while ulcerative blepharitis and meibomian blepharitis belong to posterior blepharitis.

Blepharitis Symptoms

An optometrist can blepharitis based on the appearance of the eyelid margins. But different types of blepharitis have slightly different symptoms:

  • Staphylococcal blepharitis: patients frequently exhibit mildly sticky eyelids, thicker lid margins, and lost or askew eyelashes.
  • Seborrheic blepharitis: patients have scale-like oily flakes around the bottom of their eyelashes and pink or red eyelids.
  • Ulcerative blepharitis: patients have matted, brittle crusts around the eyelashes. Removing these crusts leaves tiny sores that ooze and bleed. Patients may also lose eyelashes or experience a distortion of the eyelids’ front edges, often with chronic tearing. At worst, your cornea (the transparent front covering of the eyeball) suffers from inflammation.
  • Meibomian blepharitis: patients develop a blockage in the oil glands of their eyelids, along with unsatisfactory tear quality and redness on the lining of the eyelids.

Causes & Comorbidities

Blepharitis is more common among people with dry skin, acne, diabetes (via evaporative dry eye), or poor hygiene. This eye condition can affect people of all ages, and it can have different causes or comorbidities depending on its type. A comorbidity is a term used to point out when two diseases often accompany one another in a patient, but neither really causes the other.

Anterior Blepharitis

Anterior blepharitis is usually caused by bacteria (staphylococcal blepharitis) or scalp and eyebrow dandruff (seborrheic blepharitis). Excessive amounts of bacteria in the eyelids can cause infection. In some cases, blepharitis can develop due to allergies or a mite infestation.

Posterior Blepharitis

Posterior blepharitis is caused by the irregular production of oil in the eyelids (meibomian blepharitis). The dry, exposed inner surface of the meibomian glands’ canals makes for a decent bacterial breeding ground. It may be a result of skin conditions like rosacea or dandruff of the scalp.

In fact, posterior blepharitis also goes by the name meibomian gland dysfunction, and it’s more common than the other types of blepharitis. When meibomian glands aren’t functioning right, dry eye syndrome might not be far off.

Dry Eye & Blepharitis

Illustration of dry eyes where the area of the face around the eye looks like cracked, dry earth

Dry eye syndrome is more a group of unpleasant symptoms than a disease with a single cause, so blepharitis isn’t necessarily linked to all dry eye subtypes. But there could be comorbidity.

How the Tear Film Works

Your tear film is a triple layer of fluids that functions to keep the elements off your eyes. At its base is the mucin layer, produced by corneal and conjunctival cells dedicated to mucous production. Then, the aqueous layer sits on top, supplied by the lacrimal glands (located near your eyebrows), providing most of the moisture to your eye. The outermost layer is the oil layer, also known as the lipid layer, the layer produced by the meibomian glands.

Evaporative Dry Eye

Any disruption to these tear film layers can result in dry eye of some kind. Still, dry eye resulting from meibomian gland dysfunction (MGD) is called evaporative dry eye (EDE)

These meibomian glands produce and distribute the oil layer from the eyelids, so if you have meibomian gland dysfunction, the canals that distribute the oil layer, located in the eyelids, can fall victim to the same infections involved with other causes of blepharitis.

Rosacea Linking Dry Eye & Posterior Blepharitis

A skin condition called rosacea can cause evaporative dry eye (EDE), as well as Blepharitis.

Rosacea comes in 4 subtypes, in numerical order: type 1, erythematotelangiectatic rosacea (ETR); type two, papulopustular (or acne) rosacea; type 3, rhinophyma; and type 4, ocular rosacea. Several subtypes can contribute to blepharitis, so your optometrist will have to determine why during the course of a regularly scheduled comprehensive eye exam or an emergency one.

What Can Be Done About Blepharitis?

With all those factors to consider, you’ll probably need the help of a doctor to recover. The treatments you’ll need depend on what kind of blepharitis you have and the extent to which it relies on rosacea or dry eye.

Some dry eye treatments can take care of the problem at its root, but it may also require that your optometrist work together with a dermatologist or general practice physician. But either way, it might help to know what some go-to treatments for blepharitis might be.


Topical antibiotics like Azithromycin can help with anti-inflammatory, and it can help with the infection. Prescribed options for ointments like erythromycin and bacitracin can also help with slightly more severe cases. 

If the infection has progressed sufficiently, topical ointments applied to the eyelids might not work. In that case, you might need an oral antibiotic prescription. Taken orally, the antibiotics take effect over your whole body. Some common ones prescribed for blepharitis include:

  1. Tetracycline
  2. Minocycline
  3. Doxycycline

In Severe Cases

When other methods aren’t working so well, you might need help treating the inflammation with steroids, specifically corticosteroids. It’s usually a last-resort treatment to prevent complications from developing, rather than something used from start to finish.

Habits that Can Help with Blepharitis

Good hygiene can usually keep blepharitis at bay and under better control if you have a mild case. Hygienic practices include frequent scalp and face washing, using a warm cloth compress on the eyelids, as well as scrubbing your eyelids. It’s also advisable to stop wearing contact lenses while undergoing treatment. 

Getting Past Blepharitis

Reduce your risk of developing blepharitis by maintaining good eye health and hygiene. Routinely visit your local eye doctor, Park Slope Eye, for a comprehensive eye exam that can pinpoint its exact causes and get you on a treatment plan for other, possibly related eye diseases. Schedule an appointment online to learn more about our services.


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  • Written by Justin Bazan

    Dr. Justin Bazan is a 2004 SUNY College of Optometry graduate. He established Park Slope Eye in 2008 with the goal of providing high quality eyecare and incredible eyewear for the neighborhood. He has a true passion for optometry and stay up to date with the current research and trends. He is active in the profession and holds several leadership positions on the local, state and national levels. Dr. Bazan is a Park Slope local and can often be seen out in the neighborhood so be sure to say Hi next time you see him!

    More Articles by Justin Bazan

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