Blepharitis: treatment, symptoms, causes and whether it is contagious

The NHS says blepharitis is not usually serious and can often be treated by washing your eyelids every day. Look After Your Eyes says it is possible to make your eyes more comfortable, but in most cases blepharitis cannot be fully cured, and you may need to clean your eyelids for several months or need ongoing treatment.

NICE CKS describes the primary care approach: advising conservative treatments (eyelid hygiene and a warm compress), explaining the chronic nature of the condition and the need for ongoing treatment, managing associated conditions to reduce the risk of recurrence, and offering pharmacological treatment such as topical antibiotics when appropriate.

The NHS gives these steps for cleaning your eyes. Look After Your Eyes adds that your optometrist can advise on which method is suitable for you.

• Soak a clean flannel or cotton wool in warm water and place it on your closed eyelid for 5 to 10 minutes.

• Gently massage your eyelids for around 30 seconds.

• Clean your eyelids using cotton wool or a cotton bud. It might help to use a small amount of baby shampoo in water.

• Gently wipe along the edge of your eyelids to remove any flakes or crusts. Look After Your Eyes says to wipe from the inside corner (near the nose) to the outside corner.

• Continue to clean your eyes even if your symptoms clear up.

• Do not wear contact lenses or use eye make-up, especially eyeliner and mascara, while you have symptoms.

The NHS says blepharitis symptoms often come and go. Look After Your Eyes says symptoms tend to be worse in the morning, when your lids may be stuck together on waking, and that blepharitis normally affects both eyes. NICE CKS says there may be long periods of exacerbation and remission.

• Sore eyelids.

• Itchy eyes.

• A gritty feeling in the eyes.

• Flakes or crusts around the roots of the eyelashes.

• Eyelids sticking together in the morning when you wake up.

• Red, puffy eyelids, crusty or greasy eyelashes, burning or irritated eyes and contact lenses that are uncomfortable (Look After Your Eyes).

• In severe cases, loss of eyelashes and small ulcers and styes (Look After Your Eyes).

No. The NHS says blepharitis cannot be spread to other people. It is caused by factors such as skin bacteria, a skin condition or oil gland problems, rather than an infection passing from person to person. Even so, it is sensible to use your own flannel or cotton wool for each eye, as Look After Your Eyes advises, to avoid transferring crusts between eyes.

The NHS says blepharitis can be caused by a type of bacteria that lives on the skin, a skin condition such as seborrhoeic dermatitis, or the glands inside the eyelids not producing enough oil.

NICE CKS describes anterior blepharitis (the front edge of the lid and base of the lashes), which is usually caused by bacteria (staphylococcal blepharitis) or a seborrhoeic disorder, and posterior blepharitis (the back edge of the lid), which usually results from meibomian gland dysfunction. Mixed blepharitis has elements of both. It says associated conditions include seborrhoeic dermatitis, rosacea and dry eye disease, and that eyelid mites (Demodex) have been found in many people with chronic blepharitis, especially older people.

Look After Your Eyes says blepharitis is more common in people aged over 50 but can develop at any age. It says you are more likely to develop it if you have rosacea or seborrhoeic dermatitis, an infestation of eyelashes, or have worn contact lenses for many years.

NICE CKS says it usually develops in middle age but may also occur in childhood. If a child has red, sore, crusty eyelids that do not settle, it is reasonable to see a GP or optometrist.

Look After Your Eyes says blepharitis is not usually serious but can lead to other problems, such as styes, ulcers and conjunctivitis, if it is not treated. NICE CKS lists stye and chalazion formation, chronic conjunctivitis and contact lens intolerance, and says less frequently it can result in permanent changes to the eyelids and visual problems from keratopathy and corneal ulceration. It says serious complications are rare.

The NHS says that if blepharitis has caused other problems, such as a lump of fluid under the skin (cyst), antibiotic eyedrops or tablets may be recommended.

The NHS says a pharmacist can help with products to keep eyelids clean, and to see a GP if blepharitis symptoms do not improve or get worse.

It says to ask for an urgent GP appointment or get help from NHS 111 if you have pain in your eyes, changes to your vision such as vision loss or blurred vision, or very red eyes, because these can be signs of a more serious eye problem.

On the NHS, blepharitis is usually managed through self-care, a pharmacist and your GP, with referral to an ophthalmologist if it is severe or you have other eye symptoms. Look After Your Eyes says your optometrist can advise on lid cleaning and may prescribe antibiotic ointment or tablets if warm compresses and cleaning do not work.

Many people see a high street optometrist for an eye examination and advice on lid hygiene. Some choose a private ophthalmology consultation for persistent or severe symptoms. Because blepharitis is a long-term condition, the most important part of care is the daily routine, so ask for clear written instructions on what to do and when to return.