Posterior Blepharitis: What is it and How to Treat it | Eye Love Cares

posterior Blepharitis

There are two main types of blepharitis: posterior blepharitis, which impacts the inner edge of the eyelid along the part that touches the eyeball, and anterior blepharitis, which occurs along the outside front edge of the eyelid where the eyelashes become attached to the skin. Both are common eye disorders that are caused by either bacteria or a skin condition, such as dandruff of the scalp, or rosacea.

Posterior blepharitis can be frightening and concerning. After all, it’s never fun when your eyelids become infected, red, and scratchy. Especially when the irritation won’t go away. How do you know when you aren’t being affected by mere allergies? Additionally, how do you tell if you’ve been afflicted with a more serious condition such as posterior blepharitis? How can you get help or treat your eyes if you have this condition? Rest assured, we’ve got you covered in this complete guide about posterior blepharitis.

What is Posterior Blepharitis?

To understand posterior blepharitis, you must first understand blepharitis. Blepharitis is inflammation of the eyelids. Like many other conditions that impact this area, your eyes will become red, irritated, and itchy. The most common symptom that sets blepharitis apart from others is the dandruff-like scales that form along the eyelashes. If your eyes are red and itchy, that could be due to several problems. But, if you see a crust forming along your eyelids and flaky patches, you should consult with your eye doctor as soon as possible.

In many cases, practicing good eyelid hygiene can help control blepharitis and may help you to prevent this condition from ever happening in the first place. By frequently washing your scalp and face, using a warm compress to soak the eyelids, and scrubbing your eyelids, you can be proactive about your ocular health. Bacterial infections that lead to blepharitis may also be combated through antibiotics and other medications that your eye doctor can prescribe, although these are not always necessary.

Blepharitis can impact people of all ages. Luckily, although it is very uncomfortable, the condition is not contagious, and generally does not cause any permanent damage to eyesight. Read on to learn how to determine if you have blepharitis, how to assess its symptoms, and how to treat it.

Read More on Posterior Blepharitis Here

What is Blepharitis?

Blepharitis is an inflammation of the eyelids that causes them to become red and itchy, and that forms scaly patches of skin near the eyelashes. There are different causes, however the most common cause is the presence of bacteria. Normally, certain bacteria can live on your skin without causing you any harm. Sometimes, however, there can be bacterial overgrowth or growth of some types of harmful bacteria that can spread to the eyelids. This can cause eyes to become sore and puffy, and leads them to develop crusts and flakes around the border of the eyelid. Overall, this is what leads to the development of blepharitis.

More than twenty million Americans have blepharitis. It occurs more frequently in women, and is more common in warmer climates. These factors may be due to the fact that the use of cosmetics can lead to eye irritation and inflammation. So far, it isn’t understood why blepharitis is more common in warmer areas. There are many factors to this condition that are still being studied, which is why it’s important to consult your eye doctor if you develop flakiness around your eyelids. That way, you can undergo assessment and begin treatment immediately.

Dry Eye –

People who have blepharitis also tend to have dry eye. Dry eye is found in fifty percent of people who have contracted blepharitis. The theory is that dryness in the eyes makes your eyes less resistant to bacteria. If you ever contract blepharitis, you will also have to check in with your eye doctor regularly about dry eye. Luckily, both conditions are treatable, and if you become knowledgeable about blepharitis and take care of yourself, you can deal with it and continue living your life as usual.

Different Types of Blepharitis

As with many health conditions, there are different types and associating symptoms of blepharitis. Your eye doctor can determine the exact type of blepharitis that you have, based on the appearance of your eyelid margins. Optometrists can further recommend specific treatments depending on the type.

All cases of blepharitis are not equal; make sure that the treatment you look into or the treatment your doctor recommends matches the type of blepharitis you have. For example, chronic blepharitis, which may evolve into inflammatory eye disease, is best treated with an antibiotic/corticosteroid combination. In more severe cases, it may require oral medications. Other forms of blepharitis such as seborrheic may involve a steroid preparation. But all can be managed at home if caught early enough!

Rather than approaching each case of blepharitis with a similar treatment regimen, you should be aware that there are different treatments for the different types. Therefore, it’s important to learn how to differentiate blepharitis’s many forms. This will ensure not only proper diagnosis, but also more effective treatment.

The different types and symptoms are as follows:

  • Meibomian blepharitis causes a blockage of the oil glands in the eyelids, which results in a poor quality of tears and dry eye as the film of the eye isn’t as hydrated as it should be. Thus, causing redness along the lining of the eyelid. This is also known as posterior blepharitis.
  • Staphyloccal blepharitis patients frequently exhibit mildly sticking eyelids, missing and misdirected eyelashes, and thickened lid margins. Many patients who have this also have concurrent meibomian gland dysfunction (MGD). Warm compress masks or other meibomian gland treatments may be needed as well.
  • Seborrheic blepharitis causes greasy flakes or scales around the base of your eyelashes, and a mild redness around the eyelids. Some research suggests that Malassezia, which is a species of fungi that is commonly found on the skin, may be the culprit for this type of blepharitis. Because this type is more of a dermatological condition, its symptoms are similar to other skin conditions such as eczema. Scaly eyelids and flaky debris are typical in patients who have this type of blepharitis.
  • Ulcerative blepharitis patients have matted, hard crusts around the eyelashes. This can be a particularly concerning and uncomfortable type of blepharitis, as removing the crusts leaves behind small sores that may bleed and ooze. Patients who have this also experience eyelash loss, chronic tearing, and distortion of the front edges of the eyelids. In severe cases, the cornea becomes inflamed with this condition.
  • Demodex blepharitis is caused by intradermal parasites that thrive in your eyelash follicles and sebaceous glands. In addition to ocular inflammation and the development of chalazia and styes, demodex blepharitis is also a known risk factor for pterygium recurrence. Infestation is the most common cause of non-responsive or repeatedly persistent blepharitis. Patients who have this type of the condition typically complain of itching, irritation, and loss of eyelashes.
Acute or Chronic –

Blepharitis is also commonly defined by whether it is acute or chronic. Acute blepharitis means that you have a single or small number of infections that last up to a few weeks, and these may be either ulcerative or nonulcerative. Acute nonulcerative blepharitis is usually caused by an allergic reaction. In general, acute blepharitis is caused by a bacterial infection, such as staphylococcal, or by a virus like herpes simplex or varicella-zoster.

Chronic Blepharitis –

Although chronic blepharitis is noninfectious, the specific cause for this type of blepharitis is unknown. Chronic blepharitis indicates that your symptoms can last for months, and flare-ups are lifelong; you will have chronic blepharitis starting in childhood and continuing into adulthood. Symptoms of chronic blepharitis vary, from the meibomian glands not functioning properly and becoming clogged with hard, waxy plugs, to the glands producing low quality lipids that increase tear evaporation.

A common cause of chronic blepharitis is the seborrheic blepharitis outlined above, where the sebaceous glands become overactive, and they over-lubricate the tissues along the base of the eyelids. With chronic blepharitis, eyelashes often have flakiness, but this type of flakiness is luckily much easier to remove.  

Common Causes of Posterior Blepharitis

The main difference between anterior blepharitis and posterior blepharitis is that posterior impacts the meibomian glands of your eyelids. Keeping track of this difference will help you determine the cause of your irritation and inflammation, and will help you treat it.

Anterior blepharitis is commonly caused by:
  • Bacteria
  • Dandruff of the scalp
  • Dandruff of the eyebrows
  • Allergies
  • Mite infestation
  • Infections of the eyelids

Infections occur along your eyelids when bacteria that is commonly found on the face and the lids become excessive, or if the lid area reacts poorly to this bacteria’s presence.

Read More on Anterior Belpharitis Here

Posterior blepharitis occurs when:
  • There is a favorable environment for bacterial growth
  • Other skin conditions such as rosacea develop
  • The meibomian glands irregularly produce oil or are otherwise disrupted
  • Eyelash mites are present

Symptoms of Posterior Blepharitis

Blepharitis used to be called “granulated eyelids.” They were called this to describe blepharitis’s trademark crusty residue that builds up along the eyelids. This flaking and crusty debris may even “glue” the eyelids shut in the morning.

Symptoms always occur in both eyes, and are often at their worst as you’re waking up in the morning. Common symptoms of blepharitis, which typically are very minor, include:

  • A gritty or burning sensation in the eyes
  • Excessive tearing
  • Red and swollen eyelids
  • Itching
  • Dry eyes
  • Crusting of the eyelids
  • Irritation
  • Greasy or sticky eyelids
  • The feeling of a foreign object
  • Sensitivity to light
  • Eyelashes bending toward the eye
  • Very watery eyes
Detection –

Unfortunately, if blepharitis is detected but left untreated the condition can worsen and symptoms can further develop. More severe symptoms of the condition include:

  • Blurring of vision
  • Misdirected eyelashes
  • Missing or loss of eyelashes
  • Inflammation of other eye tissue
  • Inflammation of the cornea
  • Damage to the cornea
  • Sores or scarring that cause the eyelids to turn inward

If you do not treat your blepharitis, and rather touch and rub the irritated area, a secondary infection may result. This is what can lead to inflammation of other eye areas, the worst of which is the cornea, which is the transparent covering of the front part of the eyeball. If you have blepharitis, take care not to rub at your eyes, no matter how much they itch, as this may worsen the condition and lead to more severe eye problems down the road.

Potential Complications

While posterior blepharitis itself does not cause permanent harm to your eyes or your eyesight, the condition can unfortunately lead to further complications that may cause damage to your eyelids and eyes, or that may become something you have to deal with lifelong. These complications include:

  • Styes forming along the outside of the eyelid. They’re caused by infections that appear along the root of the eyelashes. Styes are very painful and appear as a boil-like lump or pimple that becomes filled with pus.
  • Conjunctivitis is sometimes known as pinkeye, and it is an infection of your conjunctiva. This is the thin tissue that covers the inside of your eyelids, and the white part of your eye.
  • A chalazion is a cyst that forms on the inside of the eyelids. Unless it becomes infected, luckily chalazia are normally more unsightly than painful.
  • Cornea damage may develop over time. Your cornea is more likely to become infected or damaged if you have severe or recurring blepharitis, and this may lead to further issues with your sight or your eyes down the line.

If you have blepharitis, you need to take care to ensure that none of these further complications develop. These complications not only can be unsightly, but some of them can be very painful as well, and even contagious, such as pinkeye. If you take care of yourself, get diagnosed early, and follow the instructions from your eye doctor, you can help prevent the development of these complications.

How Posterior Blepharitis is Diagnosed

Blepharitis can be diagnosed through a comprehensive eye examination. You should be getting an annual exam through your eye doctor. Testing for blepharitis will involve special emphasis on the eyelids and the front surface of the eyeball. An examination will include:

  • Patient history, to determine whether symptoms have been experienced before. This will also pinpoint any general health problems that may be contributing to the eye problem.
  • Evaluation of the quality and quantity of tears, to check for any abnormalities.
  • External examination of the eye. Your optometrist will look at the lid texture, eyelash appearance, and your skin texture around your eyes.
  • Evaluation of the lid margins, the base of the eyelashes, and the Meibomian gland openings, using bright light and magnification.

A routine exam will not hurt, nor will it further your complications from blepharitis. If you are experiencing symptoms and it’s not time yet for your annual exam, contact your eye doctor anyways; your eyes should be looked at as soon as possible, especially if you’ve had blepharitis or other eye conditions in the past.

How to Treat Posterior Blepharitis

The treatment of your blepharitis will mainly depend on the exact type of blepharitis you have. No matter the type, however, the main key to treating most types of blepharitis is keeping your lids clean and free of crusts. You do have several options when it comes to treating blepharitis: You may take on a self-care routine to alleviate your symptoms and prevent them from worsening, undergo therapy, or take medication prescribed by your eye doctor. Some blepharitis cases may require more complex treatment plans due to their severity.

Unfortunately, blepharitis does not typically disappear completely, which is why it’s important to contact your eye doctor if you’ve had it before and are experiencing symptoms again. Even with successful treatment, whether done yourself of by your doctor, there is usually a chance that blepharitis may reoccur.

Self-Care Treatment

If you have moderate blepharitis, the first thing your doctor may prescribe to you are some techniques you can apply to your eyes yourself to alleviate symptoms and aid the healing process. Patient self-care plays a major role in the management of blepharitis.

Self-care practices for blepharitis include:
  • Eyelid warm compresses
  • Eyelid cleanser
  • Consuming Omega-3 fatty acids
  • Massaging the eyelids; this will clean out any oil that has accumulated within the eyelid glands
  • Using artificial tear solutions
  • Using anti-dandruff shampoo on the scalp
  • Cleaning your eyelids with a solution that contains 50 percent tea tree oil, which is available commercially. You may also use a tea tree oil soap.
  • Stopping, or limiting, the use of eye makeup including mascara, eye liner, eye shadow, and false eyelashes or eyelash extensions
  • Temporarily discontinuing the use of contact lenses
  • Avoiding rubbing your eyes and eyelids

Omega-3 fatty acids may be a surprising aspect on this list, but this essential supplement is known to be anti-inflammatory. It is recommended that blepharitis patients take fatty acid supplements of one to three grams, two to three times daily. Be advised, however, that if you take supplements to help with your blepharitis, you should expect six to twelve months to pass before you see a definite effect. A clinical trial has shown that omega-3 supplements are beneficial for blepharitis. Although, more and larger studies are needed to clarify the role of the supplements and how they interact with other factors.

Applying warm compresses can loosen the crusts along your eyelids, and then gently scrubbing the eyelids can help remove the crusts. Take care to do this gently with warm, not hot, water.

How to do a Warm Soak for the Eyelids

  • Wash your hands thoroughly
  • Place your warm compress eye mask in the microwave for 15-20 seconds
  • Close your eyes and place the mask over your eyelids for about 10-20 minutes
  • Repeat several times during the day

Often times, a key treatment for blepharitis patients is the application of heat. This is why it’s crucial that the maskh you use has warm, not cold, effects. Heating the eyelid margin transforms fats, which are solid at room temperature, into liquids. If your meibomian glands are clogged up with a wax-like substance, this will help your secretions get flowing again.

10-20 minutes of moist heat before bedtime, and 10-20 minutes first thing in the morning, can make all the difference. You can also do warm saltwater soaks, which can be more comfortable and are less likely to wrinkle the eyelid skin. You can apply these four times a day for two weeks, then twice a day for a month, and twice a week after that. As a result, you should begin to see your eyelids improving and your comfort increasing.

How to do an Eyelid Cleansing Routine

  • Wash your hands thoroughly
  • Spray the Heyedrate Lid and Lash Cleanser onto your closed eyelids (or apply with a cotton ball or round)
  • Rub in the solution
  • Let it dry!
  • Repeat as necessary, preferably twice per day

While you’re doing an eye scrub, make sure you are practicing the right technique. People often pull down the lid and scrub the conjunctiva of the eye, rather than the lid margin. This can actually further irritate your lids and doesn’t help your condition. Dexterity can be an issue, so following instructions is critical.

Therapies Available to Treat Blepharitis

Beyond self-care practices, your optometrist may recommend some newer treatments that have made it to market and which are considered safe. Keep in mind, however, that some of these have not undergone sufficient randomized clinical trials to prove their benefits and cost-effectiveness. Some of these therapies include:

  • Intense pulsed light (IPL) therapy
    • This therapy was originally developed for dermatologists to treat rosacea. It was discovered by Roland Toyos that IPL treatment can also benefit patients who have dry eye or other conditions in their eyes. Due to the heat from the light, this treatment may help open your glands and induce secretion. The therapy operates much like a heat lamp, and Toyos reported that many of his dermatology patients could confirm that their eyes were feeling better during follow-up treatments. IPL is now used to aid eye conditions in several clinics across the United States.  
  • Thermal pulsation (LipiFlow)
    • LipiFlow is a patented device that provides heat and expresses the lacrimal gland through thermal pulsation. The result is similar to the combined action of continual blinking and the application of warm compresses. It helps re-open glands and can lead to relief for several eye conditions, including blepharitis. The 12-minute LipiFlow Thermal Pulsation Treatment has been approved by the FDA. However, it is not yet covered by insurance and generally costs $1,500 to $2,000 for both eyes. It does provide months of relief, so it may be worth the cost.  
  • Meibomian Gland probing
    • Probes that have been invented by Steven Maskin work by physically opening the occlusion that causes meibomian gland ducts to clog or close up. Due to discomfort, this procedure requires anesthetizing the patient’s eyelids, before passing a small blunt cannula probe into the meibomian glands.

Although these treatments are safe, they are still being studied and may cost a lot of money. You can discuss all of your options with your eye doctor.

Medications for Posterior Blepharitis

In cases involving bacterial infection, your eye doctor may prescribe medication. These medications include:  

  • Topical antibiotics such as bacitracin ointment can help if inflammation remains a problem. This ointment can be used at bedtime and has both antibiotic and anti-inflammatory effects. Don’t squirt creams into your eye. Instead, put a little on your fingertip and then wipe your fingertip across your closed eyelid, near your lashes. Medication applied in this way reaches the meibomian glands and conjunctiva very effectively.
  • Oral antibiotics such as long-term oral tetracycline, minocycline, or doxycycline can be more effective than topical antibiotics when it comes to treating posterior blepharitis. As little as one pill twice a week can maintain a relatively beneficial therapeutic dose for long periods of time. In fact, taking a simple Z-Pak may be an easier answer to your condition, so ask your optometrist about this.
  • Steroids such as loteprednol ointment and antibiotic-steroid combinations can work well. However, they’re not ideal; as you increase the intensity of therapy. Plus, you increase the risk of side effects or complications occurring. With steroids, you should be on the lookout for infection and cataract development. Corticosteroid use may also worsen cases of blepharitis that is caused by herpetic infections.
  • Cyclosporine (Restasis) may be very effective for blepharitis, although the results are not instantaneous. You can start out with a topical steroid, then switch to cyclosporine. Be careful, as use of this medication can worsen eye irritation in some people.

Putting an End to Posterior blepharitis

Posterior blepharitis, an inflammation of the eyelids, has impacted millions of Americans, and millions more worldwide. If you have red and itchy eyes, along with a flakiness along your eyelashes, you most likely have blepharitis.

Eye cleansing, medications, emerging treatments, and antibiotic ointments are generally effective in healing blepharitis flare-ups. However, there is no cure for blepharitis. Unfortunately, once you get it, you will either have it acutely or chronically. The best way to treat blepharitis and to take measures against developing it in the first place is to practice good eye hygiene.

As always, you should also ensure that you are seeing your optometrist regularly. They will be able to diagnose blepharitis, and will help you with the best treatment for the type of condition you have. By practicing home remedies and taking care of your eyes, even if you develop blepharitis, you will be able to keep living your best life.

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