Blepharitis: guidance for your patients

Risk factors and symptoms

Blepharitis is more prevalent in patients with:

• Skin conditions: eczema, rosacea, acne
• Allergic or atopic conditions: asthma, hay fever

These associations are thought to relate to altered sebaceous gland function (including the meibomian glands), immune system overactivity, and a chronic inflammatory state.

Common symptoms include red or irritated eyelids, crusting or flakes along the lashes, burning or gritty sensations, itching, watery or dry-feeling eyes, blurred vision that improves with blinking, and recurrent styes or chalazia. Symptoms are often worse in the morning and may be exacerbated by screen use, contact lenses, makeup, or inconsistent eyelid hygiene.

Blepharitis management

Eyelid care is the cornerstone of blepharitis management. It is focused on restoring the normal function of the meibomian gland and depends on patient’s long-term commitment to the daily routine. 

The standard three-step eyelid care routine — heat, massage, and wipe — can be shared with patients through helpful resources such as:

• Blepharitis: a practical guide to managing eyelid inflammation - patient-friendly article
• Eyelid care routine infographic - easy visual reference

Tip for active patients: lid hygiene can be incorporated into gym, sauna, or steam room routines, using the natural warmth to soften gland secretions while massaging the eyelids discreetly.

When to refer

Consider referring a patient to the secondary ophthalmic care when they present with:

• Persistent symptoms: lid discomfort, redness, or irritation does not improve despite consistent daily eyelid hygiene and any appropriate primary care interventions.
• Recurrent or complicated lesions: Frequent, large, or painful chalazia or styes that fail to respond to appropriate conservative management should be referred early. Early medical and/or surgical intervention is associated with improved outcomes.
• Visual changes: ongoing or progressive blurred vision, fluctuating vision, or other visual disturbances not explained by dry eye alone.e
• Severe inflammation or ocular pain: marked redness, pain, or photophobia that may indicate corneal involvement or other complications.
• Diagnostic uncertainty: an atypical presentation, unilateral disease, or the possibility of alternative pathology (e.g., sebaceous gland carcinoma, ocular surface disease).