Blepharitis is a common inflammatory condition of the eyelids. The lid margins become red and irritated, and typically there is dandruff-like scurf at the base of the eyelashes. Blepharitis can be acute due to either an infection or an allergic reaction. However, in most cases it is chronic, due to local inflammation from Demodex mites or dry skin. It is not a contagious and or sight-threatening condition.  There is no cure, however treatment can control the disease and manage symptoms.

Symptoms of blepharitis:

  • sore, itchy, gritty, burning or stinging sensation in the eyes
  • crusty eyelids/lashes when you wake up
  • watery eyes
  • intermittent blurry vision that improves with blinking
  • sensitivity to light

Symptoms are generally worse on waking due to the build-up of debris overnight.

 Signs of blepharitis:

  • red, swollen eyelids
  • flaking of skin around the eyelid area
  • lash loss, lash misdirection and matting of eyelashes

In cases of suspect Demodex infestation, it is possible to remove a couple of lashes and examine them under a microscope. In some cases, the optometrist/eye doctor can see mite tails at the base of the lashes.

Causes and risk factors of blepharitis:

  • Demodex mites affect people of all ages and ethnic groups but some are more susceptible to infestation of Demodex mites and not everyone will show symptoms. In the younger adult population, it affects 1 in 3; in the middle age it affects 2 in 3; for those 70years old and over, it is 100%.
  • Skin conditions such as acne rosacea, ocular rosacea, eczema, seborrheic dermatitis, dandruff and psoriasis.
  • dry eyes (specifically Meibomian gland dysfunction)
  • ocular allergic reactions
  • sunlight exposure, dusty environments
  • stress
  • makeup/facial hygiene
  • smoking


  • meibomian gland dysfunction dry eye disease
  • styes and chalazions

What are demodex mites?

Mites naturally occur in everyone’s lash follicles and sebaceous glands (meibomian and Zeiss). The species that lives in follicles (Demodex Folliculorum) are social and feed on epithelial cells of the hair follicle. Mites in the sebaceous glands (Demodex Brevis) are singular and fatter (Demodex Brevis) and feed on the tissue as well as oils produced by the glands.

The mites have about a 3 week lifespan and can lay up to 15 eggs each, so it is important to maintain regular cleaning of the lid area for at least two Demodex life cycles. Ultraviolet light is damaging to these mites so they can exist outside the glands only during the day indoors or at night. 

Demodex mites

Management and treatment of Blepharitis

  • Avoid heavy makeup especially to the lashes and eyelid margins.
  • Avoid wearing contact lenses until the blepharitis is treated and under control. Switch to daily disposable contact lenses to reduce the risk of blepharitis and dry eye disease.
  • Apply warm compresses daily to soften the crusts and oil glands around the eyes, and follow through with gentle massage of the eyelids.
  • Use commercially available foam cleansers and wipes to clean the eyelids and lashes. Typically, these products contain tea tree oil in a small concentration to kill the mites, a few at a time. Tea tree oil has anti-microbial and anti-inflammatory properties. Tea tree oil is readily available over the counter in 100% concentration. Do not use these products as they will cause chemical burns to the eye. For home therapy, use only products that are commercially made! Lid scrubs need to be performed indefinitely like brushing your teeth to keep the eyelids and lashes clean.
  • Antibiotic and/or steroid drops may be prescribed in moderate to severe cases.
Treatment of blepharitis

In-office procedures:

Mild cases:

  • Medicated swabs are designed for professional use as these have a higher concentration of tea tree oil. They are used to remove any crusty build up on the lashes and lid margins.
  • NuLids is a debridement tool designed to remove scurf and other debris that have accumulated on the lid margins and lashes. When performed in-office, a stronger concentration of tea tree oil is applied to the lashes before debridement.

Moderate to severe cases:

  • BlephEx is a very effective debridement machine that has a spinning foam head. It can eliminate the mites and stubborn hard debris that has accumulated on the lashes and eyelid margins. This painless lid debridement procedure is recommended every 6-12 months, similar to you going to the dentist and having plaque removed every 6months. Before the procedure, the optometrist prepares the eyes by applying a drop of anaesthetic eyedrop, and then inserting a pair of contact lenses to protect the corneas, the clear dome at the front of the eyes. Concentrated tea tree oil is then soaked on the eyelashes for 5-10 minutes. The BlephEx procedure takes about 5-10 minutes to perform. Before and after photographs are taken for documentation.

  • Intense Pulse Light therapy is a painless procedure that can be used as an adjunct treatment. This light therapy can heat the eyelids internally to 62degrees Celcius, which is warm enough to effectively kill bacteria and mites. It also helps release blocked oil within the meibomian glands and treat inflammation due to meibomian dysfunction dry eye, thus reducing dry eye symptoms.
  • Lipiflow is an advanced treatment for meibomian gland dysfunction dry eye disease. By clearing out blocked oils and mites within the glands, it can reduce ocular inflammation and symptoms associated with dry eye disease and blepharitis.