Blepharitis Symptoms: Do I have Blepharitis?

Waking up with crusty eyelashes or feeling like there is sand in your eyes can be more than just tiredness. Blepharitis is a chronic inflammation of the eyelids. Blepharitis is common and can be under-recognized; severity varies and many people have mild or intermittent symptoms.

Explore the full overview: See the Blepharitis symptoms and diagnosis hub for related guides.

"Blepharitis is often misdiagnosed as simple dry eye. Recognizing the specific signs on the eyelid margin is crucial for effective treatment."

Key Symptoms to Watch For

Blepharitis symptoms are typically worse in the morning. The condition typically affects both eyes. If you are experiencing persistent discomfort, check for these common indicators:

Healthy vs inflamed eyelid margins

• Red, swollen eyelids: The margins of your eyelids may appear inflamed or greasy.
• Crusts or flakes: Look for dandruff-like scales at the base of your eyelashes (collarettes).
• Gritty sensation: A feeling that something is in your eye (foreign body sensation).
• Photophobia: Mild sensitivity to bright lights.
• Frequent styes: Recurring painful red lumps near the eyelid edge.

Blepharitis stages (a practical way to think about flares)

There is no official staging system for blepharitis, but patients often experience phases. Understanding these can help you match the right level of care.

• Early irritation: Mild itching, dryness, and subtle lid margin redness that comes and goes.
• Active flare: Noticeable crusting, swelling, and burning, often worse on waking.
• Chronic changes: Ongoing gland blockage, thicker oils, and recurrent styes or chalazia.

Self-Check Tip: Look closely at your eyelash line in a mirror with good lighting. If you see tiny, tubular crusts surrounding the base of the lashes, this is a hallmark sign of Demodex blepharitis.

Anterior vs. Posterior: What's the Difference?

Doctors classify blepharitis into two main types based on which part of the eyelid is affected. It is possible (and common) to have both simultaneously.

1. Anterior Blepharitis

This affects the outside front of the eyelid, where the eyelashes attach.

• Staphylococcal: Caused by an overgrowth of bacteria (Staphylococcus) that naturally live on the skin. It often causes hard crusts and can lead to lash loss.
• Seborrheic: Associated with dandruff of the scalp and eyebrows. The scales are typically greasy and soft.

2. Posterior Blepharitis (MGD)

This affects the inner eyelid margin that touches the eyeball. It is primarily caused by Meibomian Gland Dysfunction (MGD).

Meibomian gland cross-section

Your eyelids contain tiny oil glands (meibomian glands) that secrete an oil layer to prevent tears from evaporating. In posterior blepharitis, these glands become clogged with thickened oil, leading to dry eye symptoms and inflammation.

When to See a Doctor

While home hygiene is the mainstay of treatment, you should consult an eye care professional if:

• Symptoms persist despite consistent hygiene or red-flag symptoms occur.
• You experience pain, significant vision changes, or intense light sensitivity.
• The eyelids become very swollen or hot to the touch (signs of infection like preseptal cellulitis).
• You notice eyelashes falling out (madarosis).

Note: An optometrist can diagnose the specific type of blepharitis you have using a slit-lamp examination and may recommend prescription treatments if over-the-counter hygiene is insufficient.