How does eyelid disease affect my dry eye problem?

Dry eye can occur when your eyes do not produce enough tears, or more commonly, produce tears that do not have the proper chemical composition. An imbalance in the make up of the tear film is often a result of eyelid disease. This can be anterior (blepharitis) or posterior (meibomian gland dysfunction).


Blepharitis is a common problem that produces a red-rimmed appearance to the edge of the eyelids due to inflammation. The condition is often chronic and can involve both the upper and lower lids and if left untreated may become infected.

What are the common symptoms of blepharitis?

  • Crusty, reddened eyelids
  • Itching, stinging and burning sensation in the eyes, typically with excessive watering
  • The feeling of something being in your eye (foreign body sensation)
  • Red, bloodshot eyes often with crusts forming at the base of the eyelashes
  • Eye pain

How is blepharitis diagnosed?

During an Anterior Eye Examination, your optometrist will carry out specific tests using special diagnostic equipment which allow a detailed, highly magnified view of the anterior parts of the eye. This is painless and will enable the optometrist to evaluate the health of the eye lids, tear ducts, conjunctiva and cornea of your eyes and so be able to advise a course of treatment.

How can blepharitis be treated? 

  • Blepharitis cannot be “cured”, but symptoms can be controlled with treatment.
  • Careful cleansing of the eyelid margins with specially prepared solutions is usually sufficient to keep the condition under control. The cleaning regime should be used twice daily for 3-6 weeks and then once every day for maintenance control.
  • It is often better to avoid eye make up and facial creams around the eyelids, especially when the symptoms are worse.

Prognosis and potential complications

The outcome in most cases is very good with regular treatment, but the condition is likely to return and treatment may need to be repeated.

Blepharitis typically will occur with meibomian gland dysfunction and results in dry eye symptoms.

In some cases where treatment is not carried out, or where the condition does not respond to treatment, a chronic infection may develop. This can then lead to conjunctivitis, corneal ulcers and scarring of the eyelids with loss of eyelashes.

Follow Up?

Generally no follow up is required unless the symptoms worsen or do not improve after 2-3 weeks of careful lid cleansing.

Meibomian Gland Dysfunction (MSD)

What are the meibomian glands?

The meibomian glands are vertically placed in the upper and lower eyelids. There are usually about 30 of them and they open up along the lid margins (rims of the eyelids). They produce a thin clear lipid (oily fluid) which is designed to spread over the watery layer of the tear film to slow down its evaporation.

What happens in meibomian gland dysfunction?

In MSD, the glands issue a thicker, more viscous fluid which is less effective in preventing evaporation of the tears and eventually leads to blockages of the gland openings.

Symptoms of meibomian gland dysfunction

  • The feeling of something being in your eye (foreign body sensation)
  • Burning and soreness around the eyelid edges
  • Some stickiness around the lids on waking
  • Blurry vision (typically clears on blinking)
  • Red, swollen appearance to the eyelids
  • Watering


  • First, the eyelids (which have the glands inside them) need to be warmed up for 5 minutes using a special MGD pad. This allows the plugs (blockages) in the openings to soften and reduces the viscosity (thickness) of the fluid.
  • Next, pressure needs to be applied using a finger to massage the eyelid edge to help the secretion of the fluid through the openings. This should be done to both upper and lower lids using a rolling action moving away from the nose. Repeat this action 5 times and do the whole cycle up to 4 times a day.
  • Any underlying blepharitis should be treated at the same time.

Prognosis & Associations

  • The treatment may need to be carried out for up to 6 months, but it does usually work very well.
  • Meibomian gland dysfunction often occurs at the same time as blepharitis and frequently results in dry eye symptoms.

For a comprehensive assessment and detailed advice on how to treat these symptoms, book your place on our Comfort Eyes Programme.

For a comprehensive assessment and detailed advice on how to treat these symptoms, book your place on our Comfort Eyes Programme.