Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Blepharitis is inflammation of the eyelid edges, and it's behind a huge share of the sore, gritty, crusty, red-rimmed eyes that get blamed on hay fever, tiredness or "an infection". It's chronic, it's not contagious, and there's no tablet or drop that cures it. What controls it, reliably, is a two-minute eyelid routine done daily, which is unglamorous and works. Here's what's going on, how to do the routine properly, and the products that make it easier than the old baby-shampoo method.
Blepharitis symptoms
Sore, red, swollen eyelid margins; a gritty or burning feeling; itchy eyelids; crusts or flakes at the base of the lashes, worst on waking, when the lids may be stuck together; watery or dry-feeling eyes; eyelashes that fall out or grow in odd directions; and in some people a greasy film on the lashes and recurring styes or small lumps in the lid (chalazia). Both eyes are usually affected. Vision isn't, beyond the blur that clears with a blink. It tends to flare and settle for years, which is why people assume each flare is a new infection.
What causes blepharitis?
Two main types, and most people have a bit of both. Anterior blepharitis affects the outside edge of the lid where the lashes grow: skin bacteria overgrow, or seborrhoeic dermatitis (the same thing that causes dandruff) flakes the lid skin. Tiny demodex mites, which everyone has, multiply in the lash follicles and cause the cylindrical "collarette" dandruff around the lash base. Posterior blepharitis affects the meibomian glands just inside the lid edge, which make the oily layer of the tear film; when they clog, the oil thickens, the lid edge inflames, and the tears evaporate too fast, which is why blepharitis and dry eye go together so often. Rosacea, oily skin, eczema, and age all make it likelier.
How to treat blepharitis: the daily routine
Three steps, once or twice a day during a flare, then once a day to keep it away. Done properly, most people notice the difference within two weeks and real control within six.
| Step | How | What it does |
|---|---|---|
| 1. Warm compress | A clean flannel in hot-tap water, wrung out, over closed eyes for 5 to 10 minutes, re-warmed as it cools; or a reusable heat mask | Melts the thickened oil in the glands and softens the crusts |
| 2. Lid massage | With the lids closed, roll a clean fingertip from the top of the upper lid down towards the lashes, and from the bottom of the lower lid up, for 30 seconds each | Squeezes the melted oil out of the glands |
| 3. Lid cleaning | Wipe along the lash line with a Blephaclean wipe, or cotton wool sprayed with Optase Cleanse & Protect; one wipe per eye | Removes crusts, bacteria and mite debris without the sting of diluted baby shampoo |
The NHS still mentions baby shampoo as a cleaner, and it does work, but it irritates many people and strips the tear film; dedicated wipes and hypochlorous sprays are gentler, preservative-free, and better at dealing with demodex. Tea tree-based wipes are the choice if your optician has spotted mites. Our eye care collection has the full set, including Hycosan Dual, a lipid drop that replaces the oily tear layer in blepharitis-related dry eye.
What else helps
- Keep going when it's better. Blepharitis returns within weeks of stopping. Once a day, for life, is the honest prescription.
- Omega-3 from oily fish twice a week or a supplement improves meibomian gland oil in trials; it's slow, over three months, but worthwhile.
- Treat dandruff and rosacea if you have them; an anti-dandruff shampoo on the scalp and brows reduces the seborrhoeic type.
- Go easy on eye make-up during a flare, remove it fully every night with an oil-free remover, and bin mascara after three months.
- Contact lenses are harder to tolerate with blepharitis; wear glasses during a flare and clean lids before putting lenses in.
- Don't use steroid or antibiotic drops left over from something else; see the GP section.
How long before the routine works, and what if it doesn't?
Give it a fair trial: twice a day for two weeks, then once a day for a month, before judging. The commonest reasons it fails are a compress that isn't warm enough or long enough (it needs to be properly hot to the touch and kept there for the full five minutes), cleaning without the heat and massage first, and stopping as soon as the eyes feel better. If you've done all of it for six weeks and the lids are still sore, that's the point to see an optician, who can check for demodex mites, blocked glands and the less common mimics such as eyelid eczema or rosacea, and a GP can add a short antibiotic course. The routine still continues underneath whatever else is added.
Blepharitis in children
Children get it too, often alongside recurrent styes or chalazia, and the treatment is identical: a warm flannel at bath time, a gentle lid wipe, and a parent doing it every day rather than when they remember. A child with a lid lump that keeps returning, or eyes that are persistently red and gritty, should see an optician, since untreated blepharitis in children can occasionally affect the cornea.
Blepharitis, styes and chalazia
A blocked, infected lash follicle becomes a stye: a painful red lump on the lid edge that comes to a head and bursts within a week. A blocked meibomian gland becomes a chalazion: a painless firmer lump inside the lid that can last weeks. Both are far commoner in people with blepharitis, and both respond to the same warm compress routine, done more often. Never squeeze them. A chalazion still there after a couple of months can be drained by an eye clinic.
When to see a GP or optician
See an optician or GP if the routine hasn't helped after a month, one eye is much worse than the other, the lid is very swollen, hot or painful, or you keep getting styes. Get same-day help if your vision changes, the eye is very red and painful, you're sensitive to light, or the eyelid swelling is spreading onto the cheek, which can be cellulitis. A GP can prescribe a short course of antibiotic ointment to rub into the lid margin, or oral doxycycline for a few weeks for stubborn posterior blepharitis, and an optician can look for demodex and check the glands directly. Our pharmacist can advise on which wipes and drops suit you, including with contact lenses.
Frequently asked questions
How long does blepharitis last?
It's a long-term condition that flares and settles. A flare controlled with the routine eases in two to six weeks; the tendency stays, which is why the routine does too.
Is blepharitis contagious?
No. You can share a towel without passing it on, though you shouldn't while a lid is infected or a stye is discharging.
Can blepharitis be cured?
Controlled, fully; cured, no. People who do the routine daily often go years without a flare, which is as good as a cure in practice.
Can I use antibiotic eye drops for blepharitis?
Not the over-the-counter chloramphenicol drops, which are for conjunctivitis and do nothing for the lid glands. Blepharitis antibiotics are ointments or tablets, and only from a GP when the routine isn't enough.