Blepharitis is a common condition that causes inflammation of the eyelids. It can lead to irritation, redness, flaking of the eyelids, and crusting of the eyelashes. While blepharitis often occurs without an underlying cause, it can sometimes be associated with certain systemic diseases.
Background on Blepharitis
Blepharitis typically affects the part of the eyelid where the eyelashes grow and can occur in two forms:
- Anterior blepharitis affects the outside front part of the eyelids and base of the eyelashes.
- Posterior blepharitis affects the inner edge of the eyelids, where the meibomian glands are located.
Signs and symptoms of blepharitis include:
- Redness, swelling, and irritation of the eyelids
- Flaking, scaling, and crusting of the eyelashes and eyelids
- Greasy debris accumulating at the base of the eyelashes
- Blurry vision or sensitivity to light
- Itching and burning sensation in the eyes
- Excess tearing or watery eyes
Blepharitis is typically chronic, meaning it is an ongoing condition that requires regular management. It can be uncomfortable but does not usually cause any lasting damage to the eyes when properly treated.
Systemic Diseases Associated with Blepharitis
While blepharitis often occurs in isolation, systemic diseases that can be associated with this eyelid inflammation include:
1. Rosacea
Rosacea is a common chronic inflammatory skin condition that mainly affects the central face. Ocular rosacea is a subtype that can cause eye symptoms, including blepharitis. Rosacea leads to abnormal growth and dysfunction of blood vessels, which allows inflammatory mediators to spill into surrounding tissues like the eyelids.
2. Seborrheic Dermatitis
Seborrheic dermatitis causes red, flaky, greasy skin in areas rich in oil glands like the face, scalp, and trunk. The inflammation can extend to the eyelids, triggering seborrheic blepharitis. This type of blepharitis may involve dandruff-like scaling of the eyelashes.
3. Meibomian Gland Dysfunction
Meibomian glands line the inner eyelids and secrete an oily substance that forms the outer layer of tear film. Meibomian gland dysfunction (MGD) impairs this secretion, allowing tear film to evaporate too quickly. MGD is the most common cause of evaporative dry eye, which can cause blepharitis as the dryness irritates the eyelids.
4. Demodex Infestation
Demodex are tiny mites that live harmlessly on human skin. In some cases, large numbers of demodex may infest the eyelashes and eyelash follicles. This can cause inflammation that manifests as demodicosis blepharitis. Underlying immune dysfunction may predispose some people to excessive proliferation of demodex mites.
5. Sjögren’s Syndrome
Sjögren’s syndrome is an autoimmune disorder affecting the exocrine glands, including tear and saliva glands. Chronic dryness associated with Sjögren’s syndrome can lead to dry eye disease. The resultant ocular surface inflammation and irritation promotes blepharitis in many patients.
6. Thyroid Diseases
Both hypothyroidism and hyperthyroidism have been linked to a higher prevalence of blepharitis. The thyroid hormone imbalance appears to trigger inflammatory changes in eyelid tissue. One study found up to 56% of hypothyroid patients had anterior blepharitis compared to 14% of euthyroid controls.
7. Psoriasis
Psoriasis is an autoimmune condition causing thick, scaly, red skin patches. Around 10% of people with psoriasis develop psoriatic blepharitis, with scaling and crusting of the eyelashes and eyelids.
8. Zinc Deficiency
Zinc is an essential mineral involved in wound healing and immune function. Zinc deficiency has been associated with chronic inflammation conditions like blepharitis. Low zinc levels may contribute by impairing immunity and promoting bacterial overgrowth.
Diagnosing Systemic Causes of Blepharitis
If blepharitis seems resistant to standard treatment or keeps recurring, systemic disease may be a factor. An eye care professional can check for clinical signs suggesting an associated condition, such as:
- Scaly, crusted lesions suggestive of seborrheic or psoriatic blepharitis
- Decreased tear production indicating Sjögren’s syndrome
- Greasy debris and plugging of meibomian glands pointing to MGD
- Demodex mites visible under a microscope
Laboratory testing can help confirm the presence of diseases like rosacea, Sjögren’s syndrome, and thyroid disorders. Targeted treatment of the underlying condition along with eyelid hygiene helps control blepharitis stemming from systemic inflammation.
Treating Systemic Blepharitis
Treatment approaches for blepharitis associated with systemic diseases include:
Treating the Underlying Disease
Controlling systemic inflammation helps reduce associated blepharitis. Options may include:
- Antibiotics or anti-inflammatory drugs for rosacea
- Steroids or immunomodulators for autoimmune conditions
- Hormone replacement for thyroid disorders
- Oral or topical antifungals for seborrheic dermatitis
Eyelid Hygiene and Warm Compresses
Regular lid scrubbing and warm, moist heat helps clear oils and debris from eyelids. This helps resolve inflammation and symptoms.
Artificial Tears and Ointments
Applying lubricating eyedrops and ointments provides moisture and protection to irritated eyelids and ocular surface.
Medications
Doctors may prescribe topical antibiotics, corticosteroids, or immune-modulating eyedrops to reduce eyelid inflammation and fight infection.
Dietary Modifications
A balanced diet provides nutrients that support immune function and wound healing. Dietary zinc supplements may help resolve zinc-associated blepharitis.
Demodex Treatment
Reducing demodex infestation requires daily lid scrubs with tea tree oil lid wipes combined with topical or oral ivermectin.
Preventing Recurrent Blepharitis
To help prevent blepharitis from recurring after systemic disease treatment, recommended tips include:
- Performing regular warm compresses and eyelid hygiene
- Applying eye ointments before bed to lubricate eyelids
- Following a low-fat, omega-3 rich anti-inflammatory diet
- Taking nutritional supplements like fish oil, zinc, and vitamin C
- Using prescription dry eye medication if needed
- Seeing an ophthalmologist for follow-up exams and treatment
The Bottom Line
Several systemic inflammatory diseases can increase the risk of developing chronic blepharitis. Controlling the underlying condition while practicing good eyelid care helps resolve inflammation and symptoms. Close follow-up care with an eye doctor helps ensure blepharitis stays in remission once the systemic disorder is treated.