What is blepharitis? Symptoms, causes and treatment

What exactly is blepharitis?

Blepharitis is inflammation of the eyelids, usually along the edge where your eyelashes grow. It is one of the most common things an optometrist sees. It is not contagious, but it is stubborn: it tends to settle and return, which is why so many people have been "managing" it for years.

There are two kinds, and most people have a bit of both. Anterior blepharitis affects the outer lid edge and the lash bases — crusting, flakes, redness. Posterior blepharitis affects the meibomian glands just inside the lid edge — the glands that make the oil layer of your tears. When those glands are inflamed and blocked, the tear film breaks up too fast, and that is where dry eye comes from.

Symptoms of blepharitis

• Red, swollen or sore eyelid edges
• Itching or burning
• Crusty flakes at the base of the eyelashes, worst on waking
• Watery eyes — the eye over-produces thin tears to compensate for the missing oil
• Gritty, sandy feeling
• Sensitivity to light and to wind
• Contact lenses that have become uncomfortable
• Eyes that feel worse at the end of the day, or first thing

When to see someone

If symptoms persist despite a good lid routine, or your vision changes, have it looked at. A red, painful eye with reduced vision is different from blepharitis and needs to be seen the same day.

Causes of blepharitis

Common triggers

• Bacteria that live harmlessly on everyone's skin, in higher numbers along the lid edge
• Meibomian gland dysfunction — oil that thickens and blocks the glands
• Demodex mites at the lash base, common over fifty
• Skin conditions, especially rosacea and seborrhoeic dermatitis (dandruff)
• Allergies and eye make-up left on overnight

The connection between dry eye and blepharitis

Blepharitis and dry eye go together so often that we rarely treat one without assessing the other. Inflamed lid edges block the meibomian glands; blocked glands mean no oil layer; no oil layer means the tears evaporate in seconds and the eye feels dry, burns and waters. The dryness then irritates the lid further. It is a loop, and drops on their own don't break it.

The full explanation of the two types of dry eye is on our dry eye page.

Diagnosing blepharitis

What to expect

An optometrist looks at your lid edges under magnification for redness, crusting and blocked gland openings, checks how quickly your tears break up, and — in our clinics — photographs the meibomian glands themselves so you can see whether they are blocked, shortened or healthy. That photograph is our free 20-minute scan.

Treatment options for blepharitis

At home

• Warm compress. A heat mask (not a flannel — it cools in a minute) for ten minutes, to soften the oil.
• Lid cleaning. A dedicated lid wipe or cleanser along the lash line, once or twice a day. Baby shampoo is old advice and irritates.
• Leave make-up off until the lids settle, and never sleep in it.

Over the counter

Preservative-free lubricating drops for the dryness, and tea-tree-based wipes if Demodex mites are suspected.

Medical treatment

• Antibiotic or anti-inflammatory drops or ointment, prescribed for flare-ups
• A course of low-dose oral antibiotics for stubborn posterior blepharitis
• In-clinic lid and gland treatment — a professional clean of the lid edge with a medical micro-brush, medical-grade heat, and hands-on expression of the glands. This is the EyeClean Programme, three visits over six to eight weeks, and it treats the blepharitis and the dry eye in the same session.
• Light treatment — IPL and red light — where inflammation at the lid edge keeps re-blocking the glands.

Can you treat blepharitis overnight?

Not in one night, and anyone who says otherwise is selling something. What you can do tonight: heat mask for ten minutes, clean the lid edge, leave make-up off, and sleep with the bedroom fan off. Most people wake with less crusting. A lasting difference takes two to four weeks of the routine, and if the glands are blocked, a clinic visit to clear them.

Is blepharitis contagious?

No. You cannot catch it and you cannot pass it on. The bacteria and mites involved live on everyone; blepharitis is your lids reacting to them, not an infection from someone else.

Preventing blepharitis

• Clean the lid edge daily, even when it feels fine — that is what stops it returning
• Remove all make-up before bed
• Treat the rosacea or dandruff if you have it; the lids follow the skin
• Blink properly on screens — long screen sessions halve the blink rate and let the oil harden in the gland
• If you wear contact lenses, keep lid hygiene up; lenses on inflamed lids are what makes them uncomfortable

What we do about it

Every one of our five practices treats blepharitis as part of the dry eye programme. It starts with the free 20-minute scan, which shows whether the glands behind the lid edge are involved. From there the assessment (£145) grades it and gives you a written plan, and treatment — from a home routine at £65 to the EyeClean Programme at £480 — is chosen from what we found, not sold as a package.

Written by Abra Arshad, Optometrist & Clinical Director · Clinically reviewed by Sohail Khan, Optometrist & Director · Reviewed 2026-09-23