Blepharitis: Why Your Eyelids Are Red, Itchy and Crusty, and How to Calm Them

The short answer: blepharitis is a common, long-lasting inflammation of the eyelid edges. It makes the lids red, itchy and swollen and leaves crusty, dandruff-like flakes on the lashes, usually worst in the morning. It is not contagious and rarely harms your eyesight, but it does tend to come back. A simple daily lid-cleaning routine controls most cases, and an eye exam sorts out the cases that need more, such as eyelash mites or clogged oil glands.

What is blepharitis?

Blepharitis (blef-uh-RYE-tis) simply means inflamed eyelids. It usually affects both eyes and sits right along the lid margin, where the lashes grow and where the tiny oil glands open. Eye doctors see it every day, and it often travels with dry eye, rosacea and dandruff. Many people live with it for years without knowing it has a name, blaming tired eyes, allergies or a bad mascara instead.

There are two main kinds, and many people have a mix of both:

• Anterior blepharitis affects the outside front edge of the lid, where the lashes attach. It is usually linked to an overgrowth of the normal skin bacteria on the lids, to dandruff of the scalp and eyebrows, or, less often, to eyelash mites or allergies.
• Posterior blepharitis affects the inner edge of the lid that touches the eye. It happens when the meibomian (oil) glands become clogged or thickened. This is the same problem behind much of evaporative dry eye; our post on meibomian gland dysfunction and warm compresses covers it in depth.

Blepharitis symptoms

Symptoms are typically worse first thing in the morning and can include:

• red, swollen or itchy eyelid edges;
• crusts or flakes clinging to the base of the lashes, or lids that feel stuck together when you wake up;
• lids that look greasy, or skin that flakes around the eyes;
• a gritty, burning or stinging feeling, as if something is in the eye;
• watery eyes, or tears that look foamy or bubbly;
• sensitivity to light and more frequent blinking;
• blurry vision that clears when you blink.

Over time, untreated blepharitis can cause lashes to fall out, lose color or grow toward the eye instead of away from it.

What causes blepharitis?

Often there is more than one cause at work, and sometimes no single cause is found. The most common contributors are:

• Too many bacteria on the lid margin. Everyone has bacteria on their skin; when they overgrow along the lashes, the lids become inflamed.
• Clogged oil glands. Thick, toothpaste-like oil blocks the gland openings, so the tear film evaporates too fast and the lid edge gets irritated.
• Dandruff and oily skin (seborrheic dermatitis). Flakes from the scalp and brows collect on the lashes.
• Rosacea. This facial skin condition often involves the eyelids and oil glands too, sometimes before the skin redness is obvious.
• Allergies and irritants. Reactions to eye drops, contact lens solutions or makeup can inflame the lids.
• Eyelash mites. See the next section.

Eyelash mites and Demodex blepharitis

Yes, eyelash mites are real. Demodex mites are microscopic and live in the hair follicles and oil glands of most adults, and they become more common with age. In small numbers they cause no trouble. When they overpopulate, they can trigger Demodex blepharitis: itchy, red lid edges and a telltale sign called collarettes, tiny cuffs of waxy debris wrapped around the base of the lashes like a collar.

Collarettes are easy to miss in a mirror but easy to spot at the slit lamp, which is one reason an exam matters when home care is not working. In 2023 the FDA approved the first prescription eye drop aimed directly at these mites, lotilaner 0.25% (Xdemvy), used twice a day for six weeks. Your eye doctor can tell you whether mites are part of your picture and whether that treatment makes sense for you. Treating mites with harsh home remedies near the eye can cause more irritation than it solves, so please ask first.

How to treat blepharitis at home

The foundation of blepharitis care is keeping the lid edges clean and the oil glands flowing, every day, even after you feel better. A routine that works for many of our patients:

1. Wash your hands with soap and water.
2. Warm the lids. Hold a clean, warm, damp washcloth or a microwavable eye mask against your closed eyes for 5 to 10 minutes. Re-warm it as it cools. Heat softens crusts and thickened oil.
3. Massage gently. With your eyes closed, roll a fingertip along the upper lid toward the lashes, then the lower lid upward toward the lashes.
4. Clean the lash line. Use a lid wipe, a lid-cleansing foam, or a cotton swab dipped in warm water with a few drops of diluted baby shampoo. Wipe side to side along the base of the lashes, with a fresh swab for each eye.
5. Rinse with clean, warm water and pat dry.

Do this once or twice a day during a flare and at least once a day to keep things quiet. Other habits that help:

• wash your scalp and brows with a dandruff shampoo if you have flaking there;
• take a break from eye makeup during a flare, and replace mascara and liner every few months;
• use preservative-free artificial tears for grittiness; our post on why eye drops stop working explains which kinds help most;
• avoid rubbing your eyes, which spreads bacteria and worsens the itch.

When home care is not enough

If your lids are still red and crusty after two to three weeks of steady cleaning, or if symptoms keep coming back, book an exam. Depending on what we find, treatment may include:

• prescription antibiotic ointments or drops, or in some cases oral antibiotics, which also calm oil gland inflammation;
• a short course of steroid eye drops to settle severe inflammation, with follow-up checks of eye pressure;
• prescription drops for Demodex mites when collarettes are present;
• in-office lid and lash cleaning and gland expression, which our dry eye treatment page describes;
• treatment for an underlying condition such as rosacea or dry eye, sometimes together with your dermatologist or primary care doctor.

Blepharitis or something else?

Several eyelid and eye problems can look alike at first:

• Stye or chalazion: a single bump on the lid rather than redness along the whole edge. Blepharitis makes these more likely.
• Pink eye or allergies: the white of the eye is red and there may be discharge or strong itching; our guide to red eye, pink eye and allergies helps tell them apart.
• Dry eye: burning and grittiness without much crusting, though the two often go together.
• A twitching lid: irritated, dry lids can set off a flutter; see why your eye is twitching.

Call us the same day for eye pain, a sudden drop in vision, strong light sensitivity, a red eye while wearing contact lenses, or eyelid swelling that is spreading, hot or comes with a fever. Those are not typical blepharitis.

What we check at your visit

At Reimbold Eye Group, our optometrists look at your lids, lashes and oil glands under high magnification at the slit lamp. We check for collarettes, gland blockage and the quality of your tear film, and we look at the front of the eye for any irritation of the cornea. Because blepharitis and dry eye overlap, we often evaluate both in the same visit. Every comprehensive exam with us also includes a pressure check, corneal topography, fundus photography and an OCT scan of the optic nerve, so the rest of the eye is covered too; our eye exam technology page shows what each test does.

We accept all vision plans and most major medical plans (not Medicaid). Not sure whether you need an optometrist or an ophthalmologist? Our article on optometrist or ophthalmologist explains the difference, and you can meet our eye doctors before you come in.

Glasses, contacts and blepharitis

Contact lenses can feel scratchy when the lid edges are inflamed, and debris from the lids can coat the lenses. Many patients wear glasses during a flare and go back to lenses once things calm down; our post on glasses or contacts compares the two, and our answers to everyday contact lens questions cover cleaning and care. If you need a pair you will be happy to wear more often, our face shape glasses guide is a good place to start.

Frequently asked questions

Is blepharitis contagious?

No. Blepharitis is inflammation of your own eyelid edges, so you cannot catch it from someone or pass it on. The eyelash mites linked to some cases live on almost every adult and are not considered contagious in the usual sense. It is still sensible not to share towels, washcloths or eye makeup.

How long does blepharitis last?

Blepharitis is usually a long-term condition that flares and settles rather than something that goes away for good. With a steady lid-cleaning routine most people feel noticeably better within a few weeks. Mite-related blepharitis treated with prescription drops is typically treated for six weeks.

Can blepharitis affect my vision?

It can make vision blurry for a moment, usually clearing when you blink, because oil and flakes disturb the tear film. Long-lasting, untreated blepharitis can lead to lash loss, lashes that turn inward, and irritation of the cornea, so ongoing symptoms deserve an exam.

What is the difference between blepharitis and a stye?

Blepharitis affects the whole edge of both eyelids with redness, itching and crusting. A stye is a single tender bump caused by an infected gland at the lash line. People with blepharitis get styes and chalazia more often, so keeping the lids clean helps prevent them.

Can I wear contact lenses or eye makeup with blepharitis?

During a flare, switching to glasses and skipping eye makeup gives the lids time to calm down. Once things improve, many people go back to lenses and makeup. Replace old mascara and liner, remove makeup fully every night, and avoid applying liner on the inner rim of the lid.

Blepharitis and dry eye care in Alpharetta

If your eyelids are red, itchy or crusty and home care has not done the job, we can help you find out why and make a plan that fits. Book online or call 770-776-9000. Reimbold Eye Group is at 4180 Old Milton Pkwy 1-D, Alpharetta, GA 30005. Has it been a while since your last checkup? Here is how often you should get an eye exam.

This article is for general education and is not a diagnosis. If you are worried about a symptom, call us or see a doctor.