Posterior and Anterior Blepharitis

Blepharitis is inflammation of the eyelids that often results in flaking and itching. Posterior blepharitis affects the inner eyelid near the eye. Anterior blepharitis impacts the outside of your eyelid along the eyelash line.

Both posterior and anterior blepharitis affect people of all ages. The conditions tend to occur more often in people with oily skin.

This article explains the different types of blepharitis and how you can treat them both at home and with medical care.

Posterior Blepharitis

Posterior blepharitis is the more common of the two types. It develops when oil glands in the inner eyelid allow bacteria to grow.

Called Meibomian glands, these glands secrete a type of oil that gets mixed with tears with the force of a blink. This oil is designed to prevent tear film evaporation.

When these glands are inflamed, either too much or too little oil is secreted. Red, burning eyes or dry eyes can occur, as can fluctuations in vision.

Posterior blepharitis is occur as a result of skin conditions such as acne rosacea and scalp dandruff.

It is also referred to as meibomian gland dysfunction (MGD).

Anterior Blepharitis

Anterior blepharitis affects the outside of the eyelid where the eyelashes attach.

There are three main types of anterior blepharitis: seborrheic, ulcerative, and demodex.

Seborrheic Blepharitis

Seborrheic blepharitis is associated with dandruff.

This type typically causes the eyelids to become red and produces waxy scales that build up on the eyelashes, causing the eyes to itch.

The scales initially develop due to an abnormal amount and type of tear film being produced by the glands of the eyelids.

Ulcerative Blepharitis

Ulcerative blepharitis is caused by bacteria and usually begins in childhood.

This type causes hard crusts to form around the eyelashes. These crusts often become matted during sleep, making it difficult to open the eyes in the morning.

Ulcerative blepharitis is less common than seborrheic blepharitis, but more severe.

Demodex Blepharitis

Demodex blepharitis (blepharitis caused by a mite) is an extremely common and underdiagnosed cause of blepharitis (up to 60% of cases). Demodex blepharitis can be diagnosed 100% by visualizing collarettes (cylindrical dandruff) around the eyelash base.

Self-Care Options for Blepharitis

Blepharitis is usually a chronic condition. Self-care like cleaning the eyelid, consuming fatty acids, and encouraging blinking can play a big part in managing symptoms.

Warm Compresses and Eyelid Scrubs

Blepharitis is often treated by applying warm compresses and then using an eyelid scrub.

Eyelid scrubs can be done in several different ways. Healthcare providers often recommended putting baby shampoo on a washcloth and gently rubbing the lid with it using a back and forth motion. Baby shampoo is recommended because it does not sting the eyes. 

There are also in-office procedures where the doctor can apply a treatment using a specialized device (via heat and manual expression of the oil glands) to clean the eyelid margins and decreased inflammation.

Fatty Acids

Omega-3 fatty acids are shown to stabilize the Meibomian glands and create an anti-inflammatory effect on the eye. It may take three months or longer before a definite beneficial effect is seen.

Omega-3s can be found in foods like salmon, halibut, walnuts, and flax seeds.

Check with a healthcare provider before using omega-3 supplements, especially if you have any other medical problems.

Increased Blinking

Blinking causes the expression of oil from the Meibomian glands.

Concentrating when reading or using a digital device often reduces blinking, which can cause dry, irritated eyes. Your blink rate also naturally decreases with age.

Do your best to take breaks from things like computer work. Even try to make a specific effort to stop and blink hard 20 to 30 times, four times a day.

Medical Treatment for Blepharitis

Home care may not be enough to manage blepharitis. Medicine may need to be prescribed.

Topical Antibiotics

Azithromycin is available in a topical form called Azasite. This medication tends to have an anti-inflammatory effect as well help fight infection.

Azasite comes as a solution in a dropper bottle. Healthcare providers should instruct patients to apply 1 drop into the affected eye.

Erythromycin and bacitracin ointments may also be prescribed, although they are a little thicker and harder to use on the eyelid.

Oral Antibiotics

For stubborn cases, oral antibiotics may also be prescribed.

Oral tetracycline, minocycline, or doxycycline prescribed anywhere from 30 days to much longer can be quite effective.

This is helpful especially for patients with a more severe form of blepharitis called ocular rosacea.

Corticosteroids

Although steroids can bring unwanted side effects and risks, they are very effective at quelling inflammation when more traditional methods do not work.

Healthcare providers will prescribe corticosteroids for short-term inflammation control to minimize potential complications of blepharitis.

Topical Anti-parasitics

Xdemvy (lotilaner) is an eye drop used to treat Demodex blepharitis.