8 Reasons Why Your Blepharitis Could Be Flaring Up

Blepharitis is an eye condition that causes inflammation along the eyelid. During a blepharitis flare up, you may have eyelid redness, swelling, itching, and burning. Blepharitis can cause intermittent blurred vision. It can be uncomfortable and make you more likely to develop other eye problems, like styes, chalazions, and cornea damage.

There are treatments for blepharitis that can calm inflammation and relieve your symptoms. But staying away from things that can aggravate blepharitis can keep a blepharitis flare from starting in the first place. Here are eight triggers that can make blepharitis act up.

1. Bacteria

Skin bacteria can cause a blepharitis flare. Staphylococcus, Corynebacterium, and Cutibacterium are types of bacteria that live on the skin, including the skin over the eyelids. These bacteria can cause blepharitis to act up by triggering an inflammatory response from the immune system. This causes redness, swelling, burning, and pain. 

These bacteria can also damage the meibomian glands, the glands on the eyelid that make tears. Damaged glands aren’t able to make tears with enough sebum (oils) to keep the eye lubricated. This creates an environment that makes it easier for bacteria to grow, causing a vicious cycle of inflammation and ongoing bacterial growth.

Everyone has these bacteria on their skin, including on their eyelids. But not everyone develops blepharitis. It's not clear why some people develop blepharitis from skin bacteria while others don’t. But there’s some evidence that the amount of bacteria on people’s skin may play a role. In studies, people with more bacteria on their eyelids had a higher chance of developing blepharitis. 

Antibiotic eye ointment can help treat cases of blepharitis that are triggered by bacteria.

2. Eyelash mites

Eyelash mites are tiny insects that are so small they can only be seen with a microscope. They live on people’s faces and especially along eyelashes, eyebrows, and facial hair. There are two types of eyelash mites: Demodex folliculorum and Demodex brevis. 

Demodex folliculorum lives on the eyelash hair follicles and eats skin cells. This can cause direct damage to the eyelid, triggering a blepharitis flare. Demodex brevis lives along the inner part of the eyelid on the meibomian glands. Demodex brevis eats the sebum made by meibomian glands, so tears contain less oil. This creates a situation where people are more vulnerable to developing blepharitis from other triggers.

There’s also evidence that Demodex mites themselves can trigger the immune system. This can also lead to a blepharitis flare. 

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But scientists haven’t quite figured out the relationship between Demodex and blepharitis. In studies, there was no relationship between the numbers of Demodex on a person’s eyelids and their likelihood of experiencing blepharitis. 

So, while it’s clear how these mites can trigger a flare, scientists still don’t know why Demodex mites cause blepharitis to act up in some people, but not others. 

Blepharitis from Demodex infections was often treated with a combination of treatments, including tree tea oil. But, in 2023, the FDA approved the first medication that specifically treats Demodex blepharitis. In studies, 50% of people treated with Xdemvy (lotilaner ophthalmic solution 0.25%) had significant improvement or even resolution of their symptoms. 

3. Eyelid dandruff (seborrheic dermatitis)

Seborrheic dermatitis — also known as dandruff — is best known for causing an itchy, flaky scalp. But you can develop dandruff anywhere you have lots of oil glands on your skin, like your eyelids.

People with eyelid dandruff are more likely to develop blepharitis for several reasons. First, the eyelid dandruff itself can trigger inflammation. Also, eyelid dandruff can make you more susceptible to blepharitis from other causes because it leads to a buildup of skin cells that can block oil glands and affect tear production. The buildup of skin cells also creates a fertile feeding ground for mites and encourages bacterial growth. So, people with eyelid dandruff often have several causes for their blepharitis flare.

Any skin condition that increases skin cell buildup along the eyelashes can also trigger blepharitis, not just seborrheic dermatitis. Rosacea, eczema, and psoriasis are all known to cause blepharitis to act up. 

Treatment for eyelid dandruff includes daily eyelid scrubs and warm compresses. Treating rosacea, eczema, or psoriasis can also help improve blepharitis. 

4. Dry eye

Dry eye is a complex medical condition that develops when there aren’t enough tears — or the improper consistency of tears — to lubricate the eye. This can happen when people don’t make enough tears, or when they make tears that don’t contain enough oil. 

Unlike other triggers, dry eye flare-ups don't directly cause blepharitis. But the two conditions often occur together since both are triggered by damage to the meibomian glands, which make the oily substance found in tears. Treatments for dry eye may also help relieve blepharitis symptoms and keep flares from coming back. 

5. Cosmetics

Cosmetics that come in contact with the eyelids can trigger a blepharitis flare. This includes:

• Eyeshadow

• Mascara

• False eyelashes

• Eyelash extensions 

There are a few ways that cosmetics can cause blepharitis to act up:

• Bacteria on makeup applicators: Over time, bacteria can build up on applicators and then transfer to the eyelids when you apply a cosmetic. This can increase the amount of bacteria that lives on your eyelid, which can trigger a blepharitis flare. 

• Contact dermatitis: The cosmetics themselves can trigger blepharitis and lead to a condition called contact dermatitis. Contact dermatitis is a type of allergy that develops when something touches your skin and triggers inflammation. You can develop contact dermatitis over time. This means that even if you've been using a product for weeks or months without any problems, you can suddenly develop an allergy to it.

Treatment for blepharitis caused by contact dermatitis includes warm compresses, eyelid scrubs, and staying away from products that trigger blepharitis. Experts also recommend avoiding placing eye makeup directly on the waterline. It’s also a good idea to avoid using expired eye makeup.

6. Smoke

Smoke exposure, especially ongoing cigarette smoke exposure, is linked to blepharitis. It's not clear whether smoke directly causes blepharitis or only makes people more prone to developing it. 

There’s some evidence that people who smoke are more likely to develop problems with their meibomian glands, which can then lead to blepharitis. There’s stronger evidence linking smoking to the development of dry eye syndrome. So, it's possible that smoking triggers dry eye syndrome, which then makes people more vulnerable to blepharitis.

7. Retinoids

Retinoids are a class of medication used to treat acne and other skin conditions. They’re also used to prevent wrinkles and other signs of skin aging and damage. Retinoids come as creams, lotions, and gels that are applied directly to the skin. There's also a form of retinoids called isotretinoin (Accutane) that you take by mouth.

Retinoids can damage the meibomian glands which can lead to blepharitis or dry eye. In some studies, 25% to 50% of people who use retinoids experienced either dry eye symptoms, blepharitis symptoms, or both. Although symptoms are more common among people who take oral retinoids, they can happen in people using creams and lotions, too.

Treatment for blepharitis triggered by retinoids includes switching to a different type of medication to treat acne or other skin concerns. 

8. Allergies

Allergic conjunctivitis (eye allergies) can also trigger blepharitis. People with eye allergies develop inflammation along the eye surface whenever they’re exposed to allergens, like pollen or dust. This can also trigger inflammation around the eyelid and cause blepharitis symptoms.

Treatment for blepharitis caused by eye allergies includes warm compresses and allergy medications, which can reduce symptoms of eye allergies. 

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Written by:

Nishika Reddy, MD

Nishika Reddy, MD, is an attending physician at the University of Utah. She provides comprehensive and cornea medical care at the Moran Eye Center and serves as clinical assistant professor.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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