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What Causes Dry Eyelids (Blepharitis)?

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closeup of young woman with dry flaky eyelids in low lighting

Dry, flaky eyelids can be an alarming symptom for some of our patients to wake up to. Okotoks has that southern Alberta dryness we’ve all learned to accept—leading to dry skin. But if the skin on your eyelids is noticeably drier, it could indicate some serious eye conditions. Although the connection might not seem obvious, some culprits for dry eyelids are those that trace back to certain types of dry eye.

What Could Dry Eyelids Indicate?

Dry eyelids may or may not be related to dry eyes. But dry eyelids or patches of dry skin on your eyelids could be a sign of blepharitis. To narrow it down, your optometrist will have to dig a little deeper, linking your dry eyelids to a particular type of dry eye disease.

Dry eye is quite a broad category. But if your case of dry eye is related to your oil layer,  it could cause or be caused by dry eye. Your eyelids are sensitive tissues, and they’re home to even more sensitive glands—together responsible for producing your tear film. Without a balanced and well-functioning tear film, dry eyes can result and lead to other troublesome conditions.

Your Cornea’s Dependence on Tear Film

Your cornea covers your eye and plays one of the most important roles in keeping your vision focused. It acts as an outer lens, bending light into another lens behind your pupil. To keep images crisp and sharp, your cornea needs oxygen transfer directly, because it lacks blood vessels like other tissues in your body.

It also needs moisture, so it can keep its shape and transparency. It’s a lot like skin, so without moisture, it tends to harden and cloud over. But your tear film provides a reservoir of tears to keep it hydrated and oxygenated. One key layer of the tear film is the outer one, the oil layer. It holds the moisture in, keeping it from evaporating prematurely.

Different Types of Dry Eye

But there’s more than 1 place your tear film can struggle with moisture preservation, leading to different types of dry eye. Any imbalance or underproduction in one area can dry out your eye. But some of the most sensitive sets of glands in your eye’s tear film production are your meibomian glands. These glands’ openings are directly exposed to the outside world.

Evaporative Dry Eye

A type of dry eye we see a lot of, evaporative dry eye (EDE), can stem from foreign particles blocking these openings—thus interfering with your tear film. Evaporative dry eye owes its deficiency to a lack of oil, sometimes due to a physical blockage infiltrating and widening in the meibomian glands.

If your meibomian glands experience blockages or fail to produce sufficient meibum (oil from the meibomian glands), your eyes tend to dry out. EDE means your dry eye symptoms depend on over-evaporation without protection from your oil layer. 

Meibomian Gland Dysfunction

Many dry eye diagnoses boil down to meibomian gland dysfunction (MGD). 

But either way, MGD can cause a failure to produce a steady supply of oil, leaving a gap for some kind of physical blockage in the gland. With stagnant meibum production, bacteria can take root.

MGD & Blepharitis

There’s a condition affecting your eyelids called blepharitis, characterized by inflammation. With a bacterial infection, tissues can display a few uncomfortable symptoms and might show signs of dry patches on your eyelids.

Blepharitis comes in a few subtypes, and posterior blepharitis is so closely related to MGD that eye doctors use the term interchangeably. In this way, blepharitis can go from “just” an eyelid problem to severe dry eye disease quickly.

Demodex Blepharitis

While posterior blepharitis can involve bacteria causing uncomfortable infection, there are other microorganisms that can have similar effects. Demodex mites are microscopic animals that can live on, nest in, and feed within your eyelashes. They’re a lot bigger than a bacterium, but still many times smaller than your eyelashes.

Most people have a small population of Demodex mites in their eye. But when they’re overpopulating your eye, infiltrating blocked meibomian glands, and laying eggs there, you can develop an alarming case of Demodex blepharitis. Symptoms usually include dry, flaky eyelids with discharge resembling nasal mucous gathering on the eyelashes.

Rosacea & MGD

Another skin problem called rosacea can also cause blepharitis as well as evaporative dry eye (EDE). A subtype called ocular rosacea can form as a complication of Demodex blepharitis and the bacteria it hosts, “Bacillus Oleronius” colonies. The symptoms might include dry eyelids, but there’ll more likely be broken blood vessels on your eyelids, and other uncomfortable sensations.

Treatment for Dry Eyelids

vector illustration of chemical compound hypochlorous acid.

Treatments for dry eye can vary wildly, even when you only have a niche subtype of dry eye. Only with thorough diagnostics can we determine which treatment would provide you with effective relief.

Zest Treatments

If we find blepharitis to be the cause of dry eye, infection, and inflammation surrounding your eyelids can lead to dry, crusty waste there as bacteria or mites infest the area. Zest treatments cleanse mites or bacterial infections efficiently. Zocular wipes can collect and remove these foreign bodies and soothe inflammation around your meibomian glands’ openings.

Blephex

If the bacterial infection is not quite as advanced, we can employ Blephex—a professional in-office treatment capable of exfoliating your meibomian gland openings and skin nearby

Hypochlorous Acid 

If we rule out the presence of a mite infestation in your eyelids, hypochlorous acid stands as an effective and gentle disinfectant. We tend to favour this treatment where possible because it is highly effective against bacteria, good for inflammation and it won’t significantly irritate other tissues. 

Ask Your Optometrist

As you can probably tell, it’s a long and convoluted checklist to getting a diagnosis for blepharitis, when all you’re looking for is some effective dry eye relief. Even then, we have to determine what the root cause of your meibomian blockage might be—whether microbial or mite-related—before we can provide a treatment.

If you are experiencing dry eyelids get in contact with your eye care team and book an appointment to better understand the causes and symptoms of blepharitis. 

Written by Dr. Asim Prasad

Dr. Asim Prasad is a native Calgarian who earned his Bachelor’s of Science degree in Vision Science and Doctor of Optometry degree from Nova Southeastern University in Ft. Lauderdale, Florida in 2008. Before becoming an optometrist, Dr. Prasad earned a bachelor’s degree in Environmental Science from the University of Alberta. After working in the environmental science industry for a short time, Dr. Prasad decided to pursue his true passion: optometry.
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