Posterior and Anterior Blepharitis

Both types of eyelid inflammation can be treated to manage symptoms

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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.

Blepharitis

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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 two types of anterior blepharitis: seborrheic and ulcerative.

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.

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. 

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.

Healthcare providers often tell patients to apply a small amount of Azasite to the eyelid margin with their finger at bedtime.

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.

Frequently Asked Questions

  • Can posterior blepharitis be cured?

    Both types of blepharitis are considered chronic, and some people are more prone to recurrences. These can be managed, however.

  • What can make blepharitis worse?

    Cold air, excessive screen use, not enough sleep, wearing contacts, dehydration, skin conditions like dandruff and rosacea can all make blepharitis worse.

  • Is blepharitis caused by poor hygiene?

    Blepharitis is not always caused by poor hygiene, but it can be. Bacteria that normally live on the skin can multiply when it's not cleaned often.

  • Can COVID cause blepharitis?

    Some studies have found a correlation between the two. While it is known that COVID-19 can enter the body through the eyes, it is less clear whether contact with infected eye fluid can transmit the virus.

  • What deficiencies cause blepharitis?

    Low levels of vitamins A and D have been linked to eye problems, including dry eye and blepharitis.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Ophthalmologists. What Is Blepharitis?

  2. Putnam CM. Diagnosis and management of blepharitis: an optometrist's perspective. Clin Optom (Auckl). 2016;8:71-78. doi:10.2147/OPTO.S84795

  3. American Optometric Association. Blepharitis.

  4. Merck Manual. Blepharitis.

  5. National Eye Institute. Blepharitis.

  6. Oleñik A, Mahillo-Fernández I, Alejandre-Alba N, et al. Benefits of omega-3 fatty acid dietary supplementation on health-related quality of life in patients with meibomian gland dysfunction. Clin Ophthalmol. 2014;8:831-6. doi:10.2147/OPTH.S62470

  7. Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and ameliorationBMJ Open Ophthalmol. 2018;3(1):e000146. doi:10.1136/bmjophth-2018-000146

  8. British Oculoplastic Surgery Society. Overview: What is blepharitis?.

  9. Sen M, Honavar SG, Sharma N, Sachdev MS. COVID-19 and eye: A review of ophthalmic manifestations of COVID-19Indian J Ophthalmol. 2021;69(3):488-509. doi:10.4103/ijo.IJO_297_21

  10. Duignan E, Kenna P, Watson R, Fitzsimon S, Brosnahan D. Ophthalmic manifestations of vitamin A and D deficiency in two autistic teenagers: case reports and a review of the literatureCase Rep Ophthalmol. 2015;6(1):24-29. Published 2015 Jan 24. doi:10.1159/000373921

Additional Reading
  • Lavine, Jay B., MD. The Eye Care Source Book. Contemporary Books.

By Troy Bedinghaus, OD
Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.