Blepharitis

Ricarda Schwarz studied medicine in Würzburg, where she also completed her doctorate. After a wide range of tasks in practical medical training (PJ) in Flensburg, Hamburg and New Zealand, she is now working in neuroradiology and radiology at the Tübingen University Hospital.

More about the experts All content is checked by medical journalists.

Blepharitis is inflammation of the eyelids. The cause is usually a disturbed sebum flow from the sebum glands of the eyelids. The disease is widespread and leads to burning eyes, crusty, reddened eyelids and a feeling of foreign bodies. Treatment often includes antibiotic eye ointments and thorough eyelid hygiene. Here you can read everything you need to know about blepharitis.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. H01

Blepharitis: description

Inflammation of the eyelids (blepharitis) occurs when the ducts of the sebum glands that open to the outside at the edges of the eyelids become blocked. Bacteria are often involved in such an inflammation of the eyelids.

Since this disease often forms white-gray, greasy scales on the edge of the eyelid, it is also known as blepharitis squamosa. If the course is severe, it can turn into ulcerative blepharitis with deeper skin lesions on the eyelid.

Other inflammation of the eyelids

Blepharitis (blepharitis squamosa) is primarily used when the inflammation affects the entire eyelid. If, on the other hand, clogged sebum glands cause a narrow, painless swelling of the eyelid, it is a hailstone.A stye, on the other hand, is a painful, reddened swelling on the eyelid, which is caused by a mostly bacterial inflammation of a sebum gland.

Blepharitis: symptoms

Common symptoms of blepharitis include:

very sticky eyelashes (especially after waking up)
dry, burning, or itchy eyelid
slightly reddened and flaky eyelid
Foreign body sensation in the eye
increased loss of eyelashes on the inflamed eyelid margin (madarosis)
sometimes formation of fine scales on the edge of the eyelid
sometimes slight swelling of the eyelids

Blepharitis: causes and risk factors

Blepharitis is caused by a blockage of the sebum glands (meibomian glands) in the eyelids. This can have different causes:

People who have excessive sebum production (seborrhea) and who also suffer from acne, neurodermatitis or rosacea, for example, are particularly susceptible to this. With excessive sebum production, the sebum glands become clogged particularly easily, which is why blepharitis is often chronic.

In addition, external stimuli such as dust, wind, cold, heat, smoke, chemicals, cosmetics or contact lenses can cause blocked sebum glands and thus inflammation of the eyelid. General illnesses such as rheumatism, thyroid disease or diabetes are also possible causes of blepharitis.

Infectious blepharitis

Infectious blepharitis is usually caused by bacteria (staphylococci), viruses (herpes simplex virus, the chickenpox virus varicella zoster) or pubic lice:

Staphylococci colonize the skin and mucous membranes even in healthy people. In the event of a minor injury, they can penetrate the skin of the eyelid and cause inflammation.
The herpes virus causes the well-known and often recurring painful blisters on the mouth. After an infection, it can survive in the nerve endings and later trigger an infection again. If this affects the eyelid, blepharitis can develop.
Pubic lice can be transmitted from person to person in poor hygienic conditions. Mostly they affect pubic hair, less often armpit and beard hair and very rarely the eyelashes (Phtiriasis palpebrarum). The hair on the head is not affected. As part of an eyelid inflammation, the nits of the lice adhere to the eyelashes as small grains. The lice themselves suck on the edge of the eyelid between the eyelashes.

Non-infectious blepharitis

The edge of the eyelid consists of an outer and an inner part. The eyelashes are located on the outer edge of the eyelid, while the sebum glands are located on the inside, the secretion of which is released at the edge of the eyelid. With the tear film it is distributed on the surface of the eye with every blink of the eye so that the eyelid can glide over it without friction.

If the sebum production exceeds the normal level, the ducts of the eyelid glands clog - a scaly eyelid inflammation (blepharitis squamosa) can develop. The excess secretion sticks the eyelashes together and forms a greasy coating that additionally clogs the glands and can cause inflammation in the case of bacterial or viral colonization.

Blepharitis: examinations and diagnosis

The right contact person for (suspected) blepharitis is the ophthalmologist. Most of the time, he can diagnose the eyelid inflammation at first glance. For a successful therapy, however, it is important to find out whether certain risk factors have favored this eyelid inflammation. Therefore, the doctor will first find out more about your symptoms and medical history in a conversation (anamnesis). Possible questions are:

Do you have slightly oily (seborrhoeic) skin? For example, did you suffer from acne as a teenager?
Do you suffer from copper rose (rosacea) or neurodermatitis (atopic dermatitis)?
Do you wear contact lenses?

The ophthalmologist then examines the anterior and posterior edge of the eyelid with a magnifying glass. To do this, he carefully folds the lid down.

In the case of scaling inflammation of the eyelid margin (blepharitis squamosa), the ophthalmologist can recognize white-gray, fatty scales on the edge of the eyelid. Deeper skin lesions suggest advanced inflammation (ulcerative blepharitis). Using a slit lamp examination, the ophthalmologist can determine whether the cornea has also been injured as a result of the inflammation. He can also run a small cotton swab along the eyelid to take a swab. This is examined more closely in the laboratory to find out whether the lid is colonized with germs.

Blepharitis: treatment

Thorough eyelid hygiene is crucial to the treatment and prevention of blepharitis. It includes cleaning measures with which the built-up sebum secretion is removed from the ducts of the sebum glands. In addition, the edges of the eyelids are carefully cleaned. In the case of infectious blepharitis, suitable agents are given to counter the cause of the infection (e.g. antibiotics against bacteria). In addition, an existing causal skin disease should be treated properly.

Lid hygiene

The aim of eyelid hygiene is to ensure normal drainage of the sebum secretion. This usually succeeds with two measures that should be carried out daily:

Lid massage: To empty the excretory ducts of the sebum glands, the eyelids are first heated (e.g. with warm compresses, special thermal goggles or infrared light) and then massaged with clean fingers or cotton swabs - with the eyes closed, gently stroke the upper and lower eyelids several times in the direction of the eyelid.
Cleaning the edges of the eyelids: The adhesions and crusts on the edge of the eyelid that often accompany blepharitis can be removed from the pharmacy with a damp cloth, hypoallergic soap and salicylic oil. Then the edges of the eyelids are cleaned with a special cleaning solution or with specially made, lint-free cleaning pads. These special products for eye care for eyelid inflammation are available in pharmacies.

Treatment of infectious blepharitis

If the eyelid inflammation is caused by bacteria, it is treated with a local antibiotic preparation (e.g. antibiotic eye ointment). Only in rare cases is the antibiotic given in the form of tablets.

In certain cases, the local application of glucocorticoids ("cortisone"), for example as an ointment, can be useful.

For blepharitis caused by a virus, the doctor may prescribe an anti-viral drug (antiviral) to take.

Pilocarpine oil can be used against pubic lice. It stops the lice from breathing, which then dies. They are removed by hand along with their nits. Alternatively, an ointment with a low content of mercury can be used for this form of eyelid inflammation.

Treatment of skin conditions

If blepharitis is based on a general skin disease, this must be treated at the same time in consultation with the attending ophthalmologist. Otherwise, blepharitis can return quickly.

Blepharitis: disease course and prognosis

Usually, the prognosis for eyelid inflammation is good. However, it can also prove to be downright persistent. A permanent disappearance of blepharitis in people with excessive sebum production can usually only be achieved through consistent eyelid hygiene.

If the disease is severe, the harmless inflammation of the eyelid margin can lead to bacterial ulcerative blepharitis. The eyelids are often swollen, red and overheated. Pus settlements (abscesses) and deeper skin injuries (ulcers) with yellowish crusts are part of this clinical picture. If left untreated, this form of the disease can lead to permanent eyelid misalignment. This is because scar tissue occasionally develops during wound healing, which warps the edge of the eyelid outwards (ectropion) or inwards (entropion). Fortunately, this complication of blepharitis is very rare.

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