Flaky Eyelids: Causes and Risk Factors
Here's The Eyelid Disease Everyone Should Know About, According To An Ophthalmologist
When your vision is blurry, go to your eye doctor. Wash your hands before putting your contacts in. That's pretty much all there is to know about eye health, right? Think again.
As with any other part of your body, your eyes can get sick or infected—and while that's not pleasant to think about, it's important to consider what your eyes are up against so you know how to protect them and what your treatment options might be.
One of the most common (and rarely discussed) eyelid diseases is Demodex blepharitis. To get more insights on the disease, we spoke with Neda Shamie, M.D., an ophthalmologist and a cataract, LASIK, and corneal surgeon based in Los Angeles.
Prevention: What is Demodex blepharitis and what causes it?
Dr. Shamie: Demodex blepharitis is a common—yet often misdiagnosed—eyelid disease that is caused by an infestation of Demodex mites, the most common species of ectoparasite (parasites that attach themselves to human skin). These microscopic mites can exist on anyone's body in low volumes and are not typically a cause for concern. However, when Demodex mites overpopulate in and around the eyelids, it can lead to a condition called Demodex blepharitis.
Prevention: How can you tell if you have Demodex blepharitis?
Dr. Shamie: The common signs of Demodex blepharitis that we look for are redness or inflammation around the eyes, missing or misdirected eyelashes, and the presence of collarettes.
Prevention: What are collarettes?
Dr. Shamie: Collarettes are cylindrical, waxy, crusty debris of mite waste and eggs found at the base of the eyelashes. Collarettes on the eyelids are the telltale sign of Demodex blepharitis: 100% of patients with collarettes have Demodex blepharitis.
Collarettes are the telltale sign of Demodex blepharitis. Note the waxy cylindrical debris at the base of the lashes and the misdirected and abnormal eyelashes.
TarsusPrevention: Is there anything you can do to prevent a Demodex mite infestation?
Dr. Shamie: I always stress the importance of maintaining healthy eye habits—obtaining regular eye exams, eating a healthy diet, removing eye makeup every night, and wearing UV protective eyewear in the sunlight—but it is not possible to prevent Demodex blepharitis as the mites can infiltrate the eyelid for no apparent reason. It is extremely common, and can impact all genders, ethnicities, and ages.
Prevention: Can someone tell if they have Demodex blepharitis without consulting an eye doctor?
Dr. Shamie: No, only an eye care provider can properly diagnose Demodex blepharitis. Consistent eye exams should be a part of everyone's proactive healthcare journey, but in between regular checkups, a patient should consult an eye care provider if they experience any type of ocular discomfort or feel that something is not "right" with the way their eyes look or feel.
Prevention: How prevalent is Demodex blepharitis? Can anyone get it?
Dr. Shamie: Demodex blepharitis impacts approximately 25 million eye care patients in the U.S. That's one out of every 12 adults. While research has shown that patients with other eye conditions—such as dry eye, cataracts, and glaucoma—exhibit Demodex blepharitis, the disease can impact patients across ages and all levels of eye health. Many people don't know that they're living with this disease, though, because other eye diseases share similar symptoms.
Demodex mites can exist on everyone's skin; it's only when these mites overpopulate that they can become an issue. If I see Demodex blepharitis during an eye exam, the first thing I do is inform patients that the disease is quite common and we can get it under control. These mites live on everyone, and they are merely dealing with an overgrowth of something that's very natural. And the last thing they want to do is leave a disease that can be a cause of long-term problems untreated.
Prevention: What are the consequences of leaving Demodex blepharitis undiagnosed or untreated?
Dr. Shamie: Inflammation from Demodex blepharitis can cause a domino effect and can be a complicating factor in the management of overall eye health.
Prevention: So how can you treat Demodex blepharitis?
Dr. Shamie: Until recently, the only management options for Demodex blepharitis were eyelid hygiene based, such as cleaners, warm compresses, and exfoliation procedures, none of which are FDA approved. Everyone responds differently to treatment, but patients often have to perform these tasks daily to potentially obtain relief from symptoms. And none of these eyelid hygiene related options treat the root cause of the disease, which is the mite itself.
In July of 2023, the FDA approved XDEMVY (lotilaner ophthalmic solution) 0.25%, which is the first and only FDA-approved prescription eye drop treatment to directly target Demodex mites, the root cause of Demodex blepharitis. This treatment requires one drop in each eye twice daily (approximately 12 hours apart) for six weeks.
The first step of treating Demodex blepharitis is getting diagnosed. To receive proper diagnosis and to figure out which treatment works for you, patients should always consult with an eye doctor and make sure they understand all possible side effects for any prescribed medications. In clinical trials, the most common side effect for XDEMVY was stinging and burning in 10% of patients, and, in rare cases (less than 2% of patients), chalazion/hordeolum and punctate keratitis. Your doctor will be able to advise on your risk of developing these side effects, and what to do if they occur.
See additional Important Safety Information and full Prescribing Information for XDEMVY below.
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.
For additional information, please see full prescribing information available at: www.Xdemvy.Com.
What Is Blepharitis (Eyelid Inflammation)?
Medically reviewed by Johnstone M. Kim, MD
If you've ever experienced itchy, red eyes with crusts or flakes around the eyelids, it's possible you were dealing with blepharitis. Blepharitis is a common condition that can affect both children and adults. It is characterized by chronic inflammation of the eyelids, typically affecting the part of the eyelid where your eyelashes grow. Although blepharitis can be uncomfortable, it can generally be treated quickly and is not contagious.
Eye care doctors, such as optometrists or ophthalmologists, can diagnose and treat blepharitis. If you think you might have blepharitis, you can ask your healthcare provider for a referral to an eye care specialist. Through a comprehensive eye exam, they can identify the cause of your symptoms and recommend a course of treatment.
TypesThere are two types of blepharitis, which are defined by the area of the eye that is affected and what caused it. You can have one or both types at the same time. The types are:
Anterior blepharitis affects the portion of your eye where your eyelashes connect to your eyelid. Common causes of this type include a bacterial infection, seborrheic dermatitis (dandruff), and a combination of these two causes.
Posterior blepharitis affects the part of your eyelid that touches your eye. Common causes of this type include rosacea and meibomian gland dysfunction (MGD), which is characterized by poor functioning of the tiny oil glands in your eye called the meibomian glands.
Blepharitis symptoms and their severity can vary from person to person. If you have blepharitis, you may experience any of the following symptoms in or around your eyes:
Stinging or burning
Watering or creating tears
Itchiness
Sensitivity to light
Redness
Swelling
Dryness
Feeling like there's something in your eye
Crustiness or dandruff-like flakes on them, especially when you wake up
Foamy tears (tears with small bubbles)
Over time, if blepharitis is untreated, it can lead to more severe symptoms, including:
Blurry vision
Eyelashes falling out
Eyelashes growing in the wrong direction
Swelling in the eye, such as in the cornea (the outermost layer of your eye)
Related: 4 Causes of Bumps on Your Eyelid
What Causes Blepharitis?We know of a few causes of blepharitis at this time, and researchers are still studying other potential causes. Most cases—particularly anterior blepharitis cases—are caused by having too much bacteria (such as staphylococcus) at the base of your eyelashes. It's normal to have bacteria on your skin, but if it grows too much in this area, it can cause blepharitis.
It's also possible to develop blepharitis if:
Your eyelid oil glands (the meibomian glands) are clogged or irritated
A type of face mite called a Demodex lives in your eyelash follicles
Your eyelids produce less oil than average
You may be more likely to develop blepharitis if you also experience:
Seborrheic dermatitis (dandruff), a type of eczema that primarily affects the oil (sebaceous) glands
Rosacea, a chronic skin condition that causes areas of red, inflamed skin
Allergies that affect your eyelashes
People with oily skin may also find that they are more prone to developing blepharitis than those with dryer skin types.
DiagnosisTo determine if your eye condition is blepharitis, it's best to seek care from an eye care specialist. They can perform a comprehensive eye exam in which they use special instruments, such as a light and a magnifying tool, to test your eyes and take a closer look at your eyelids and eyelashes.
Your eye care specialist may also ask about your health history and other medical conditions you have, to determine what might be causing your symptoms. They may also perform tests to identify the quality of your tears. If they determine that blepharitis is the cause of your symptoms, your eye care specialist can use the eye exam to tell you the type of blepharitis you have and recommend appropriate treatment options based on the type and its cause.
Treatments for BlepharitisIn treating blepharitis, it's important to manage both the symptoms and the ongoing treatment of any underlying causes. Your eye care specialist can recommend a comprehensive course of treatment, which may include a combination of eye hygiene and prescription medication.
Eye HygieneThe most effective way to reduce instances of blepharitis—and prevent recurrence—is through a daily routine of cleaning your eyelids. This can involve the following:
Make sure to clean your eyelids every day with water and a face cleanser, or baby shampoo.
If the crusts on your eyes are stubborn, warm compresses can help loosen them.
If your oil glands are clogged, you can try to massage your eyelids to help move the oil out.
You may want to avoid wearing eye makeup while seeking treatment, to make it easier to keep your eyes clean.
For certain kinds of blepharitis, prescription medication may be necessary. This may include:
If your eyes are very swollen, red, or irritated, your eye care specialist might prescribe eye drops with steroids. If you don't need steroids, they may recommend you try artificial tears, a common type of eye drop found over the counter.
If your blepharitis is caused by bacteria, your eye care specialist may prescribe antibiotic eye drops, pills, or ointments.
To treat underlying conditions such as rosacea or dandruff, your healthcare provider may prescribe medication or special skincare or hair products.
Although blepharitis is common and can be treated, there's a good chance it will come back. Make sure to keep up with your eye hygiene practice and continue to treat any underlying conditions.
PreventionIt's important to maintain proper eye hygiene to help prevent blepharitis flare-ups.
If you are diagnosed with blepharitis, make sure to speak with your eye care specialist about what causes your blepharitis, and continue to prevent the root cause as needed. For example, if you typically experience blepharitis related to bacterial infections, your provider may prescribe you medication to reduce the flare-ups.
Potential ComplicationsIf blepharitis is left untreated, it can lead to other issues, particularly with your eyes. The following issues may occur:
Styes, or red bumps on the eyelid resulting from clogged oil glands
Chalazions, or lumps on the eyelid from a stye that hasn't gone away
Dry eye
Damage to your cornea due to swelling or eyelashes growing in the wrong direction
Redness in your eyes that lasts for a long time
Related: How To Treat a Stye and Stop One From Ever Happening
A Quick ReviewBlepharitis, a common eye condition that can cause irritation, redness, and itchiness, is often characterized by the flaky crusts it produces on the eyelids. It can be caused by a variety of factors, from bacteria to clogged oil glands to underlying conditions such as rosacea.
Although common, blepharitis can be a difficult condition to manage. It's important to develop a treatment plan with an eye care specialist to reduce your symptoms and prevent future severe occurrences. Maintaining good eye hygiene and addressing underlying causes can help you manage your blepharitis.
Frequently Asked QuestionsIs blepharitis a symptom of autoimmune disease?
No, blepharitis is not a symptom of autoimmune disease, but it can easily be confused as one. Blepharitis is common in people with rosacea, which itself is not an autoimmune disease but can co-occur with autoimmune diseases. Therefore, it's possible for someone who has an autoimmune disease to have a higher chance of blepharitis, but there's not a direct connection.
In addition, blepharitis is often confused with a type of eye rash caused by the autoimmune disease lupus, but having lupus does not increase your risk of blepharitis.
Can stress and anxiety cause blepharitis?
No, research does not suggest that blepharitis is caused by stress or anxiety. However, research does show that people with diagnosed blepharitis have higher stress and anxiety levels than people without; it's suggested that this is tied to the discomfort and stress around managing the condition.
When should I be concerned about blepharitis?
Most of the time, blepharitis can be managed using simple hygiene techniques, per your healthcare provider's recommendations. However, if your symptoms don't improve or become worse after several days of treatment, it's important to reach back out to your healthcare provider.
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How To Identify And Treat Eyelid Dermatitis
Eyelid dermatitis causes the skin on or around the eyelid to become dry, itchy, and irritated. Moisturizing the skin, avoiding allergens, and applying topical medication are some ways of managing itchy eyelids.
"Eyelid dermatitis" may refer to contact dermatitis, atopic dermatitis, or seborrheic dermatitis on the eyelids. When the cause is an allergen or irritant, the condition is called eyelid contact dermatitis.
This article discusses how to recognize the symptoms of eyelid dermatitis. It also looks at how to manage eyelid dermatitis with medical treatments and home remedies, causes of the condition, and more.
Dermatitis on the eyelids causes inflammation of the thin, sensitive skin around the eyes. The eyelids become:
It can affect one or both of the eyes.
If this condition persists, the eyelids can become thickened in a process called lichenification.
When eyelid dermatitis occurs due to an irritant, symptoms typically develop within a few hours or days of contact with a trigger substance. Symptoms usually subside after a person removes the trigger.
For all types of eyelid dermatitis, it is best to keep the eye area clean and avoid touching it or scratching. This helps prevent further irritation or infection.
Other treatments may depend on the cause of eyelid dermatitis. As the skin on the eyelids is thin and delicate, it is best to contact a doctor or pharmacist for advice before applying any topical treatments.
Identifying and avoiding triggersWhere possible, it is helpful to identify and avoid contact irritants and allergens that can cause flare-ups. These can include:
Moisturizing creams can relieve dryness and itching. A wide range of creams is available with and without prescription.
It is best for people to contact a doctor or pharmacist for advice first, as some moisturizers can also cause dermatitis.
Using calcineurin inhibitorsThis medication treats inflammatory disorders, including atopic dermatitis. They are available as a cream or ointment, which is particularly suitable for delicate areas of skin.
A person should use calcineurin inhibitors with caution, as they may cause side effects such as itching and burning.
Using corticosteroidsA person can apply steroid-based creams directly to the eyelids to treat inflammation and reduce dryness.
For widespread cases of dermatitis or eczema, a doctor may recommend corticosteroids in tablet form. The strength of the medication depends on the severity of the symptoms.
People should use corticosteroid creams cautiously as they can lose some of their effectiveness if a person applies them for too long. When a person applies them close to the eye for long periods, there is a risk of glaucoma.
These creams can also induce certain short-term side effects, such as acne, hair growth in the area, and thinning of the skin.
Corticosteroid tablets are reserved for the most severe symptoms, as their side effects can be serious. Possible effects include:
A person's doctor can help them identify the cause of eyelid dermatitis and advise on a suitable treatment plan.
Learn more about topical and oral steroids for eczema.
There are several types and causes of eyelid dermatitis.
Allergic contact dermatitisAllergic contact dermatitis develops due to an allergic reaction that causes inflammation of the skin, such as pollen in a person with hay fever.
Some cosmetic products or metals, such as nickel, are common causes of allergic skin reactions.
Irritant contact dermatitisIrritant contact dermatitis can happen when the eyelid comes into direct contact with a substance that irritates the outer layer of the skin. Examples include certain types of makeup, soaps, and detergents.
Atopic dermatitisThis can develop on the eyelids and cause other eye issues. It is unclear what causes atopic dermatitis, though there seems to be a genetic component.
Learn more about atopic dermatitis.
Seborrheic dermatitisSeborrheic dermatitis is a common condition that causes the skin to become inflamed and flakey. It often occurs on the scalp but can also affect oily areas of skin, such as the eyelids.
If eyelid dermatitis is due to contact with an allergen or irritant, it may resolve on its own once a person avoids the trigger.
However, the exact cause of eyelid dermatitis is not always clear, such as in the case of atopic dermatitis. This means that a person may require treatments to encourage symptoms to heal, as there is no known trigger to avoid.
Preventive measures may also help eyelid dermatitis to clear up. These measures include avoiding harsh soaps and eye makeup.
The following actions may help prevent outbreaks of eyelid dermatitis:
The causes, types, and triggers of eyelid dermatitis vary. It may be necessary to try several of these actions before finding the most effective ones. A person's doctor can also help them find ways to prevent a dermatitis flare-up.
The skin around the eyes is thin and delicate, and so the eyes are susceptible to irritation.
While it is difficult to predict who will develop eyelid dermatitis, certain factors may increase its likelihood. These include:
If a person experiences persistent symptoms of dermatitis or if symptoms do not respond to home treatments, it is best to contact a doctor for advice. A doctor may be able to diagnose the form of dermatitis via a physical exam and asking questions about symptoms.
If the doctor suspects an allergy, they may recommend a patch test. This involves placing a common allergen on the skin to test for an allergic reaction.
Some complications that may occur with eyelid dermatitis include:
Receiving an accurate diagnosis and following a suitable treatment plan can help reduce the risk of complications.
Here are some common questions about eyelid dermatitis.
How do I get rid of dermatitis on my eyelid?In some cases, avoiding triggers can help clear eyelid dermatitis. If symptoms are due to a condition such as atopic dermatitis or seborrheic dermatitis, a person may require topical medication, like topical calcineurin inhibitors and corticosteroids.
What triggers eye eczema?Numerous allergens and irritants can trigger eye eczema. Examples include eye makeup, eye drops, false eyelashes, swimming goggles, and airborne allergens.
What is an alternative treatment for eyelid dermatitis?If a person wishes to try home treatments for eyelid dermatitis, these can include moisturizing, avoiding harsh soaps, and wearing protective eyewear when spending time around triggers. However, in some cases, medical treatments may be necessary to help manage symptoms.
There are several possible causes of eyelid dermatitis, including contact dermatitis, atopic dermatitis, and seborrheic dermatitis. It can cause symptoms such as dryness, itchiness, and skin irritation.
Depending on the cause, it may be possible to treat eyelid dermatitis with moisturizers, calcineurin inhibitors, and corticosteroids. Avoiding triggers and taking preventive steps may also help.
It is best to contact a doctor as soon as a person has concerns about eyelid dermatitis. They can help determine the cause and advise on treatments to help manage symptoms and reduce flares.
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