Anterior and posterior blepharitis
Anterior blepharitis affects the front of the lid margin, at the lashes: bacterial colonization produces crusts and collarettes around the lash bases, demodex mites produce cylindrical sleeves of debris on the lashes, and seborrheic dermatitis produces greasy scales. Posterior blepharitis affects the back of the margin, where the meibomian glands open, and overlaps with meibomian gland dysfunction and ocular rosacea. Most patients have elements of both.
Symptoms
Red, itchy, swollen lid margins; crusting on waking; a gritty, burning sensation; watering; light sensitivity in flare-ups; loss or misdirection of lashes; and recurrent styes and chalazia. Contact lenses become intolerable. Symptoms wax and wane over years.
Diagnosis
The slit lamp shows the lid margin in detail: the type of debris, the state of the gland openings, the redness and thickening of the margin, and, with lash epilation and microscopy, the presence of demodex. The tear film and cornea are examined for the effects. Identifying the dominant cause directs treatment.
Treatment
- Lid hygiene: warm compresses to loosen debris, then cleansing of the lash line with a dedicated lid cleanser or diluted baby shampoo, daily during flares and several times a week thereafter
- Demodex: tea tree oil based lid wipes, or the prescription drop lotilaner, which kills the mites over six weeks; in-office microblepharoexfoliation, which cleans the lash bases mechanically, may also be recommended, and the evaluation determines whether it is right for you and whether it is offered at our offices
- Bacterial: antibiotic ointment at the lid margin for a few weeks
- Inflammation: short courses of a mild steroid or steroid-antibiotic combination for flares
- Rosacea related: oral doxycycline for its anti-inflammatory effect, and intense pulsed light
- Meibomian gland dysfunction alongside: thermal gland treatment and expression
- Preservative-free lubricants for the dry eye component, and omega-3 supplementation
Living with blepharitis
Because it recurs, maintenance matters more than any single treatment. A short daily routine of compresses and lid cleansing keeps most patients comfortable, with periodic in-office treatment when needed. Replace eye makeup regularly and remove it fully each night. Blepharitis is treated before any eye surgery, because an inflamed lid margin raises infection risk.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is what is affecting your vision is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
