Eyelid inflammation: symptoms, causes and treatment

Eyelid inflammation, also known as blepharitis, is inflammation of the edges of the eyelids. It's about the edge where your lashes are and where there are tiny sebaceous glands. When these glands become inflamed or do not function properly, blepharitis occurs. The disorder is very common in people of all ages, although it is slightly more common in adults. It is also more common among people with sensitive skin or skin conditions such as rosacea or eczema.

In blepharitis, the sebaceous glands in the eyelid margin do not function properly. Normally, they produce an oily film that helps keep your eyes moist. When these glands become blocked or produce too much sebum, an ideal environment for bacteria is created. The most common causative agent is a bacteria that lives naturally on the skin, often Staphylococcus aureus. This bacteria grows on excess sebum in the hair follicles of eyelashes and in the sebaceous glands. It is not a serious infection but more of a chronic irritation.

Sometimes an ingrown eyelash can also lead to inflammation. A subcutaneous nodule, called a chalazion or hordeolum, can also develop, which is associated with the blockage of sebaceous glands. Eyelid inflammation can occur once but often becomes chronic. This means that complaints keep coming back, sometimes with quiet periods in between. This chronic character makes it especially annoying, although luckily it's not dangerous for your eyesight.

Eyelid inflammation is caused by a combination of factors that all have to do with the functioning of sebaceous glands. The sebaceous glands in your eyelids produce an oily substance that normally helps distribute tear fluid and prevent evaporation. In people with blepharitis, these glands do not work optimally: they can produce too much sebum or the sebum is too thick and clogs the exit. When sebaceous glands become clogged, sebum buildup occurs. This creates a breeding ground for bacteria that live naturally on your skin, the most abundant of which is Staphylococcus aureus. These bacteria multiply and cause inflammatory reactions.

Skin disorders also play a role. People with rosacea, a chronic skin condition with redness, are more likely to have eyelid infections. Eyelids may also be affected by eczema. In these conditions, the skin is naturally more sensitive. Hormonal fluctuations can affect the functioning of sebaceous glands, so eyelid infections are sometimes more common during puberty, pregnancy or menopause.

Environmental factors can also contribute. Dry air caused by air conditioning or heating can irritate eyelids. Long-term work on the screen where you blink less can also worsen symptoms. If you blink less, tear fluid is not distributed properly and eyelids can become drier. Contact with certain substances can also trigger eyelid inflammation, such as makeup around the eyes, new face creams or cleansing products. Certain eye drops or contact lens cleaning products can also cause irritation for sensitive people.

The symptoms of an eyelid infection are usually easily recognisable and fairly typical. The most common symptom is a burning sensation in the eyelids. This can range from mild to quite annoying and is often worst in the morning after waking up or in the evening when you are tired. Some describe it as feeling itchy or chafing. Itching is another common phenomenon where the eyelid edge itches, which can cause rubbing, but this makes the inflammation worse. Your eyelids often feel irritated and tired, like you have sand in your eyes. This uncomfortable feeling can make it difficult to concentrate, especially when working that involves reading or looking at a screen.

When looking in the mirror, you can often see changes. The eyelid edge is redder than normal and there are often small white or yellowish flakes or scabs between the lashes. This looks like dandruff but on your lashes. Eyelids may also be slightly swollen. Sometimes your eyelids stick slightly shut in the morning due to secretions that have accumulated overnight. It helps to gently clean your eyes then.

With prolonged blepharitis, eyelashes may become thinner or fall out. They can also grow in the wrong direction. Fortunately, lashes usually grow back when the inflammation is under control. In some cases, not only the eyelid but also the eye itself is affected. The whites of the eyes may be red and you may have light sensitivity. This may indicate a complication that also needs attention.

Eyelid inflammation focuses on the edges of the eyelids, where the eyelashes come out of the skin and where the sebaceous glands are located. Both the upper and lower eyelids may be affected, or both. Often, both eyelids of both eyes are affected at the same time, but it can also start on one side. The base of the lashes is a typical spot for changes, where sebum and dander build up and cause the characteristic scabs and flakes.

When a chalazion or hordeolum develops, it is a small lump on the eyelid. A hordeolum, also known as stye, sits at the edge of the eyelid and is often painful. A chalazion, or hail, sits deeper in the eyelid and is less painful but visible as swelling. More severe or prolonged eyelid inflammation can also affect the conjunctiva, which is called secondary conjunctivitis.

The treatment focuses on reducing inflammation, improving eye hygiene and preventing recurrence. The main treatment is regular cleaning of the eyelid edge. It is best to do this twice a day, in the morning and in the evening. To do this, use a special eyelid cleanser (such as a gel or liquid from the pharmacy) on a cotton swab or gauze.

Hot compresses can also help. Place a clean washcloth soaked in warm water over your closed eyes for five to ten minutes. The heat helps to open clogged sebaceous glands. After the warm compress, it is a good time to cleanse the eyelid edge.

If eye hygiene isn't helping enough, your doctor may prescribe medication. This may include eye drops or an eye ointment containing antibiotics that fight the bacteria. The treatment usually takes several weeks. In some cases, antibiotics are combined with anti-inflammatory drops that contain a mild corticosteroid to help reduce inflammation. This type is only used for a short time and under the supervision of a doctor. In persistent cases, the doctor may sometimes prescribe antibiotics in tablet form, especially for people who also have rosacea.

For people with a chalazion or hordeolum, a minor procedure may sometimes be necessary to remove the lump. It is important to realize that eyelid inflammation is often chronic. Even after successful treatment, complaints can recur. Good eye hygiene therefore remains important, even in periods without symptoms.

Simply washing your eyes extra often with water does not help enough. Water alone does not remove sebum and flakes well enough. You really need a mild cleanser like baby shampoo or special eyelid cleanser. Continuing to use makeup during active inflammation is not wise. Mascara, eyeliner, and eye shadow can worsen inflammation and further block sebaceous glands. Do not use eye makeup until the inflammation is under control.

Self-treatment with random antibiotic ointment or drops that are still in the house is not recommended. Not all antibiotics work against these bacteria and some eye drops may have side effects. Only use medication that your doctor has specifically prescribed. Short-term treatment usually does not work for chronic blepharitis. Many people stop cleaning as soon as acute symptoms are over, but that is too early. You often have to keep up the treatment for weeks and continue to cleanse preventively afterwards.

Pulling off persistent flakes or scabs vigorously can cause damage. This can damage the skin, pull out eyelashes, and aggravate inflammation. First, gently loosen crusts with a warm compress. Continuing to wear contact lenses during active eyelid inflammation is not wise. The lenses may aggravate irritation and become contaminated. Switch temporarily to glasses until symptoms have disappeared.

Is eyelid infection contagious?

No, eyelid infection is not contagious. Although bacteria play a role, you cannot transmit the condition to others. The problem lies in the malfunctioning of your own sebaceous glands, not in contracting an infection.

Can an eyelid infection affect my vision?

In most cases, no. A common eyelid infection is limited to the edge of the eyelid and does not affect your vision. Only in rare cases with very prolonged inflammation can the cornea be affected. That is why it is important to consult a doctor if symptoms persist.

How long does an eyelid infection last?

This is very variable. An acute episode can heal within a few weeks with appropriate treatment. However, many people have a chronic form that keeps coming back. With good eye hygiene, you can often keep complaints under control.

Should I avoid makeup?

During active inflammation, it is better not to use eye makeup. Mascara and eyeliner can clog sebaceous glands. When your eyes are calm again, you can use makeup again, but always remove it before bed. Also, change mascara regularly.

When should I see an ophthalmologist?

Go to the ophthalmologist if, in addition to eyelid problems, you also have eye pain, if your vision decreases, or if you are very light-shy. Even if your eye is very red and not just the eyelid, a visit is wise. These symptoms may indicate a complication.

Is there anything I can do to prevent eyelid inflammation?

Good eye hygiene is the best prevention. Always remove eye makeup before bed. If you have sensitive skin or have had problems before, you can preventively cleanse your eyelid edge from time to time. Blinking enough while working on the screen and ensuring sufficient humidity can also help.

1. Skindr dermatologists
2. Health & Science, Eyelid Inflammation (Blepharitis)
3. eBPNet (Evidence-Based Practice Network)
4. Thuisarts.nl, Eyelid inflammation
5. NHG Standard The red eye