Overview

Blepharitis is inflammation of the eyelids that causes them to become red and itchy and form scaly patches of skin near the eyelashes. There are different causes of blepharitis. Staphylococcal blepharitis is a type of blepharitis caused by staphylococcus (or “staph”) bacteria. Normally, certain types of staph bacteria can live on your body without causing harm. However, sometimes there can be bacterial overgrowth or growth of some types of harmful bacteria that can infect the eyelids. This can cause eyes to become sore and puffy and develop crusts and flakes around the eyelid border.

Most cases of staph blepharitis are thought to be caused by Staphylococcus aureus. This is the bacteria responsible for most staph infections, including food poisoning, other skin infections, and some types of pneumonia. They’re commonly found on your skin and inside your nostrils. They are more likely to cause serious illness the deeper they are in your body.

More than 20 million Americans have staph blepharitis. It’s more common in warmer climates and may occur more frequently in women. The cause of staph blepharitis isn’t known.

Dry eye is found in 50 percent of people who have staph blepharitis. One theory is that dryness in the eyes makes them less resistant to bacteria. Staph blepharitis can be acute. This is when you have a single or small number of infections that last up to a few weeks. More often it’s chronic and can last for weeks or months, frequently starting in childhood and continuing into adulthood.

Other types of blepharitis and what causes them

While staphylococcus is a common cause of blepharitis, there are other causes that can lead to blepharitis.

Acute blepharitis

Acute blepharitis can be ulcerative or nonulcerative. Acute ulcerative blepharitis is caused by a bacterial infection, usually staphylococcal. It can also be caused by a virus, like herpes simplex or varicella-zoster.

Acute nonulcerative blepharitis is usually caused by an allergic reaction.

Chronic blepharitis

Chronic blepharitis is noninfectious. However, the specific cause is unknown. In one type of chronic blepharitis the meibomian glands don’t function properly and become clogged with hard, waxy plugs. The meibomian glands in the eyelid produce lipids that reduce tear evaporation. Another cause of chronic blepharitis is seborrheic blepharitis due to overactive sebaceous glands. The glands produce an oily substance that lubricates tissues at the base of the eyelids. With seborrheic blepharitis, the eyelashes often have flakiness that resembles the crusting seen with staphylococcal blepharitis, but it’s much easier to remove.

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Symptoms

Blepharitis used to be called “granulated eyelids.” This describes the crusty residue that builds up on the eyelids. Symptoms almost always occur in both eyes and are often worse when waking in the morning. They may include:

  • itchiness, soreness
  • redness and irritation
  • puffy, swollen eyelids
  • greasy or sticky eyelids
  • flaking, crusty debris that may “glue” the eyelids shut
  • sensation of a foreign substance or something gritty in the eyes
  • sensitivity to light
  • very watery or very dry eyes
  • eyelash loss or discoloration
  • eyelashes bending toward the eye
  • sores or scarring that can cause the eyelids to turn inward (in severe cases)
  • damage to the cornea, or outer layer of your eye (in rare cases)

Symptoms specific to staph blepharitis

The following symptoms could indicate staph blepharitis specifically:

  • collarettes, which are rings of flakes lining the eyelids at the base of the eyelashes
  • broken eyelashes or loss of eyelashes
  • discolored and hazy areas, called infiltrates, in the lower part of the cornea
  • symptoms occurring mainly on the outside, or anterior, portion of the eyelid

Complications

  • A chalazion is a cyst that forms on the inside of the eyelid. Unless it becomes infected, a chalazion is normally more unsightly than painful.
  • Styes usually form on the outside of the eyelid. They are caused by infections at the root of the eyelashes. Styes are painful and appear as a boil-like lump that is normally filled with pus.
  • Conjunctivitis, or pinkeye, is an infection of your conjunctiva. This is the thin tissue that covers the inside of your eyelids and the white part of your eye. Pinkeye can be highly contagious.
  • Your cornea may be more likely to become infected or damaged if you have severe, recurring staph blepharitis.

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Diagnosing staphylococcal blepharitis

Your ophthalmologist (eye doctor) will likely be able to diagnose your blepharitis by inspecting your eyes. Often, the magnifying lenses doctors use to conduct eye exams are used to get a closer look at the tissue surrounding your eye and the eye itself. To determine if your blepharitis is caused by staph bacteria, the ophthalmologist will take a sample of the dandruff-like flakes around your eye. The sample will be tested in a lab to see if staph bacteria are present.

Treatment

Often the first time you get staph blepharitis it will clear up by itself if you keep the areas around your eyelids clean and use artificial tears. Treatments for staph blepharitis may include:

  • moistening the residue on your closed eyelids with warm compresses and massaging them gently
  • washing your eyelids with prescription cleansers, over-the-counter eyelid cleaning pads, or diluted baby shampoo
  • cleaning your eyelids with a solution containing 50 percent tea tree oil, which is available commercially
  • applying prescription antibiotic ointments or drops to the edge of your eyelids after they’ve been cleaned thoroughly
  • applying steroids via antibiotic ointment, in chronic or more severe cases
  • taking oral antibiotics for persistent cases
  • using procedures to remove residue, dead skin, and bacteria (e.g., electromechanical debridement, thermal pulsation, or intense pulsed light, which are sometimes used but haven’t been formally tested by researchers)

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Steps you can take

  • Don’t wear contact lenses while you have active staph blepharitis.
  • Skip eyeliner and mascara until symptoms are gone.
  • Avoid rubbing your eyelids.

Outlook

Eye cleansing and antibiotic ointments are usually effective in healing a staph blepharitis flare. However, there is no cure for it and it often recurs. Good eye hygiene can help prevent flares.

Prevention

These steps may help prevent blepharitis. They also can reduce the number and severity of staph blepharitis flares for people who already have the condition.

  • Clean your eyelids daily with warm water, an over-the-counter eyelid cleanser, or diluted baby shampoo. Always wash your hands thoroughly with soap before cleaning your eyelids.
  • If you have dry eyes, use artificial tears to keep them moist.
  • You may benefit from taking an omega-3 fatty acid supplement. These supplements help fight inflammation.