Doctors categorize blepharitis based on where it occurs (Anterior vs. Posterior) and what causes it. Identifying your specific type is crucial because a treatment for bacterial blepharitis might do nothing for mite-induced inflammation. People often describe "MGD eyes" as dry, tired, and irritated, especially after screen use.
1. Staphylococcal Blepharitis
This is an Anterior form, meaning it affects the outer eyelid where the lashes attach. It is caused by an immune response to Staphylococcus aureus bacteria.
- Key Signs: Hard, brittle crusts (fibrinous scales) around the base of the lashes. When removed, they may leave a small ulcer that bleeds.
- Symptoms: Intense itching, lash loss (madarosis), and trichiasis (lashes turning inward).
- Treatment Focus: Antibiotic ointments and rigorous lid hygiene to lower bacterial load.
2. Seborrheic Blepharitis
Also an Anterior form, this is associated with seborrheic dermatitis.
- Key Signs: Soft, greasy scales that do not stick tightly to the lash base. The lid margins look oily and shiny.
- Symptoms: Burning and stinging, often less severe than the Staphylococcal type.
- Treatment Focus: Managing the underlying dermatitis (e.g., anti-dandruff shampoos for scalp) and gentle lid cleaning.
3. Meibomian Gland Dysfunction (MGD)
This is the primary form of Posterior blepharitis and is arguably the most common cause of dry eye worldwide.
The meibomian glands line the inner eyelid. In MGD, the oil they produce thickens (like toothpaste), clogging the gland openings.
- Key Signs: Capped or plugged oil glands along the waterline. When pressed, cloudy or thick yellow paste comes out instead of clear oil.
- Symptoms: Tears evaporate quickly, causing burning and "tired eyes," especially when using computers.
- Treatment Focus: Warm compresses and massage are essential to melt and express the oil.
4. Demodex Blepharitis
Caused by an infestation of Demodex mites.
- Key Signs: Cylindrical dandruff (collarettes)—a tube of clear waxy debris extending from the skin up the eyelash shaft.
- Symptoms: Itching is the hallmark symptom, often worse in the morning.
- Treatment Focus: Tea tree oil based cleansers (e.g., TTO 5-50%) or newer prescription drops like lotilaner ophthalmic solution.
Related content
FAQs
What are the different types of blepharitis?
The main types are staphylococcal, seborrheic, meibomian gland dysfunction (MGD), and Demodex blepharitis.
What is the difference between anterior and posterior blepharitis?
Anterior affects the lash line, while posterior involves the meibomian glands along the inner lid margin.
How do I know if I have Demodex blepharitis?
Itching and collarettes (cylindrical debris) at the lash base are common clues.
Can you have more than one type of blepharitis?
Yes. Mixed forms are common, especially when MGD overlaps with anterior inflammation.
Does MGD mean I have blepharitis?
MGD is a major cause of posterior blepharitis and is often treated in the same way.