8 Reasons Why Your Blepharitis Could Be Flaring Up

Blepharitis is an eye condition that causes inflammation along the eyelid. During a blepharitis flare, you may have eyelid redness, swelling, itching, and burning. Blepharitis won't harm your vision. But blepharitis 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. 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. 

SPECIAL OFFER

Get XDEMVY^® (lotilaner ophthalmic solution) 0.25%

Tarsus is committed to making XDEMVY affordable and accessible. Majority of patients will pay as little as $30.* For access support, contact Tarsus Connect at 1-866-846-3092.

Learn more

Sponsored By

*With payer coverage and available assistance options, and based on eligibility requirements. Terms and Conditions apply.¹

©2025 Tarsus Pharmaceuticals, Inc. Tarsus, the Tarsus logo, XDEMVY, and certain other trademarks herein are trademarks of Tarsus Pharmaceuticals, Inc. US—2500105 2/25

¹XDEMVY Savings and Access Terms and Conditions

Full Prescribing Information

Important Safety Information

Indications and Usage

XDEMVY (lotilaner ophthalmic solution) 0.25% is indicated for the treatment of Demodex blepharitis.

Important Safety Information

Most common side effects: The most common side effect in clinical trials was stinging and burning in 10% of patients.  Other side effects in less than 2% of patients were chalazion/hordeolum and punctate keratitis. 

Handling the Container: Avoid allowing the tip of the dispensing container to contact the eye, surrounding structures, fingers, or any other surface in order to minimize contamination of the solution. Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions.

When to Seek Physician Advice: Immediately seek a physician’s advice concerning the continued use of XDEMVY if you develop an intercurrent ocular condition (e.g., trauma or infection), have ocular surgery, or develop any ocular reactions, particularly conjunctivitis and eyelid reactions. 

Use with Contact Lenses:  XDEMVY contains potassium sorbate, which may discolor soft contact lenses. Contact lenses should be removed prior to instillation of XDEMVY and may be reinserted 15 minutes following its administration.

To report SUSPECTED ADVERSE REACTIONS, contact Tarsus Pharmaceuticals at 1-888-421-4002 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

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 oils (sebum) to keep the eye lubricated. This creates an environment that makes it easier for bacteria to grow, causing a vicious circle 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 quite 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 oils (sebum) made by meibomian glands, damaging tears. 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. 

But like bacteria, 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 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, seborrhea 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 proper 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 doesn’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, and eyelash extensions. There are a couple of ways that cosmetics can cause blepharitis to act up.

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. 

Also 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 an inflammatory response. 

An inflammatory response causes the symptoms of blepharitis, such as redness, swelling, and irritation. 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. It’s also recommended to avoid placing eye makeup directly on the waterline. 

6. Smoke

Smoke exposure, especially ongoing cigarette smoke exposure, is linked to blepharitis. It's not quite 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 having 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, and 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 and 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

Eye allergies (allergic conjunctivitis) 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 inflammatory response 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 allergy. 

Why trust our experts?

Written 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.

Reviewed 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.

Our editorial standards

Meet our experts