Dry Eye, Blepharitis and Demodex
Red, irritated, itchy or crusty eyelids are often called blepharitis. But that is really only the beginning of the diagnosis.
Many of the patients I see have already tried eye drops, warm compresses and eyelid wipes. They improve for a while — and then the symptoms return.
That is when I look more closely.
Blepharitis can be associated with meibomian gland dysfunction, Demodex, ocular rosacea, allergy and dry eye. Understanding what is driving the inflammation is the first step towards treating it properly.
I don't believe in simply adding more eye drops when we haven't first understood why your eyes are uncomfortable.
— Dr Cheryl Lee, Ophthalmologist
Do You Wake Up With Crusty, Itchy Eyelids?
Blepharitis is one of the most common eyelid conditions and a major cause of dry eyes, styes and irritated eyes. Fortunately, it can usually be controlled with the right treatment and eyelid care.
What is Demodex?
Demodex is a mite in eyelash follicles that consumes skin oil. Research indicates that 44% of blepharitis patients have Demodex which increases with age.
What can get rid of Dermodex? Blephex!
How I treat blepharitis
I don't believe in simply adding more eye drops when we haven't first understood why the eyes are uncomfortable.
— Dr Cheryl Lee
There isn't one treatment that is right for every patient.
Treatment depends on whether the main problem is inflammation of the eyelid margin, blocked meibomian glands, Demodex, allergy, ocular rosacea, dry eye — or a combination of treatments.
Blepharitis Treatment in Singapore
What is blepharitis?
Blepharitis is inflammation of the eyelid margins, where your eyelashes and the openings of your oil glands sit. It is extremely common and often goes together with dry eye.
Some people see redness or crusting. Others just feel that their eyes are tired, gritty, itchy, watery or uncomfortable, especially by the end of the day. Other signs include:
- flakes or crusts around the eyelashes
- burning or stinging
- swollen or tender eyelids
- recurrent styes or blocked oil glands
- blurred vision that comes and goes
- contact lenses becoming uncomfortable
Blepharitis is not always simply an eyelid hygiene problem.
Why does it keep coming back?
This is one of the questions I hear most often. Blepharitis can have several causes at once:
Meibomian gland dysfunction. The tiny glands along your eyelids make the oil that stops your tears from evaporating. When they are blocked or make poor-quality oil, the eyelids become inflamed and the tears become unstable.
Demodex. These microscopic mites live around the eyelashes. A few cause no trouble, but too many can lead to inflammation, itching and debris at the base of the lashes. Lubricating drops alone are unlikely to solve this.
Ocular rosacea. Rosacea can involve the eyelids and the eye surface, sometimes even when the skin symptoms are mild.
Allergy and inflammation. Allergy, blepharitis and dry eye often overlap, and rubbing your eyes makes things worse. That is why I examine the eyelids and the eye surface rather than treating every itchy, red eye the same way.
Blepharitis and dry eye
Every time you blink, your eyelids spread a fresh layer of tears across your eye, and the oil glands help keep it there. When the eyelids and glands are unhealthy, tears evaporate too quickly.
The problem isn't that you need more tears. It is that the tears you have are disappearing too quickly. That is why treating the eyelids is often part of treating dry eye.
How I treat it
- Professional eyelid cleaning. When there is debris or build-up around the lashes that is hard to clear at home, we use BlephEx to clean the eyelid margins and the base of the lashes.
- Treating the oil glands. If the glands are blocked, treating them is often more useful than adding drops again and again. The aim is better quality, better flowing natural oil.
- Eye-Light. For selected patients, blue and red light with Intense Pulsed Light (IPL) may be part of treatment, particularly when blepharitis comes with gland dysfunction, inflammation or ocular rosacea.
- A home routine you can keep up. I show you how to care for your eyelids and recommend products suited to your eyes. I prefer a routine that is effective and realistic enough to become part of everyday life.
Your questions
Do eye drops cure blepharitis?
Drops can soothe the eyes, but they do not treat the underlying eyelid problem. That is why some people use drops several times a day and still wonder why their eyes feel dry.
Can blepharitis be cured permanently?
Blepharitis is often a chronic condition. For many patients the realistic goal is not to promise it will disappear forever, but to find the causes, treat them properly and keep the eyelids and eye surface healthy over the long term. Once you understand why it keeps coming back, managing it becomes much easier.
Is blepharitis contagious?
Most chronic blepharitis is not considered contagious. However, red eyes can have many causes, including infection, so have your eye examined if it becomes suddenly very red, painful or light-sensitive, or has significant discharge.
Can Demodex cause blepharitis?
Yes. Too many Demodex mites can contribute to inflammation around the lashes and eyelid margins. There are characteristic signs I look for at an examination, and when Demodex is part of the problem, treatment should address it directly.
When should I see an eye doctor?
Come and see me if your eyelids are red, itchy or crusty, your eyes are gritty or tired, or you keep getting styes, especially if drops are not helping or the problem keeps returning. Please be seen promptly if an eye becomes suddenly very red, painful or sensitive to light, or if your vision changes.
Eyelash extensions and blepharitis
Eyelash extensions are attached to your eyelashes. It's important to wash them daily with a special lid wipe for hygiene. Without this, bacteria and mites can grow, leading to toxins that may cause eyelid inflammation (blepharitis).
Dr Cheryl Lee's Personal Experience
“Blepharitis isn’t simply an infection—it’s often part of a wider problem affecting the eyelids, meibomian glands and tear film. Rather than treating only the symptoms, I look for the underlying cause so that treatment can be tailored to each patient.”