Blepharitis and rosacea are two common chronic inflammatory skin conditions that can affect the eyes and eyelids. They share some similarities, which can lead to confusion about whether blepharitis is a type of rosacea. Here is a detailed look at the relationship between blepharitis and rosacea.
What is Blepharitis?
Blepharitis is a chronic inflammation of the eyelids. It causes red, swollen, itchy eyelids and irritation or burning of the eyes. Some common symptoms of blepharitis include:
- Red, swollen, flaky eyelids
- Crusting along the eyelashes
- Greasy flakes or scales on the eyelids
- Itching or burning sensation in the eyes
- Excess tearing
- Sensitivity to light
- Blurred vision
There are two main types of blepharitis:
- Anterior blepharitis – inflammation of the outer eyelid affecting the eyelashes. This is the most common type.
- Posterior blepharitis – inflammation of the inner eyelid closest to the eyeball.
Blepharitis is very common and tends to affect adults between 30-50 years old. It often occurs due to bacteria, allergens or skin conditions like dandruff or seborrheic dermatitis. The exact cause is often unknown. Risk factors for developing blepharitis include:
- Bacterial infection
- Allergies or allergic conjunctivitis
- Scalp dandruff or seborrheic dermatitis
- Rosacea
- Styes or chalazia
- Dry eyes or tear film insufficiency
- Demodex mites
- Contact lens wear
What is Rosacea?
Rosacea is a chronic inflammatory skin condition that mainly affects the face. It often begins as reddening on the cheeks, nose, chin or forehead that may come and go. Over time, rosacea can lead to small visible blood vessels, swelling and skin thickening.
Common symptoms of rosacea include:
- Facial redness, flushing or blushing
- Bumps or pimples on the face
- Burning or stinging on the face
- Visible broken blood vessels
- Swollen skin
- Eye irritation
There are four main subtypes of rosacea:
- Erythematotelangiectatic rosacea – flushing, redness, visible blood vessels
- Papulopustular rosacea – acne-like breakouts
- Phymatous rosacea – thickened skin, irregular surface nodularities
- Ocular rosacea – dry eyes, watery eyes, swelling of eyelids or conjunctiva
Rosacea often occurs in adults between 30-60 years old and affects women more than men. The exact cause is unknown, but may involve immune system dysfunction, microbes, neurovascular dysregulation and genetic factors. Triggers can make rosacea worse, like sun exposure, spicy foods, alcohol, hot temperatures, stress and skin care products.
Is There a Connection Between Blepharitis and Rosacea?
There appears to be an association between blepharitis and rosacea. Many people who have rosacea also develop blepharitis. And blepharitis is very common in the ocular rosacea subtype.
Estimates on the prevalence of blepharitis in rosacea patients vary widely from 37% to 72%:
- One study found 72% of rosacea patients had anterior blepharitis.
- Another study found 44% of patients with rosacea had blepharitis.
- One survey reported 37% of people with rosacea experienced blepharitis.
So blepharitis seems to be more common in those with rosacea compared to the general population. This suggests the two conditions are linked in some patients.
Shared Causes Between Blepharitis and Rosacea
Researchers believe blepharitis and rosacea may be connected because they share similar causes and risk factors:
- Demodex mites – These microscopic mites live on the skin and are found in higher amounts on the faces of people with rosacea and blepharitis.
- Bacteria – The bacteria Staphylococcus epidermidis has been implicated in both blepharitis and rosacea.
- Inflammation – Both involve chronic inflammation, which can spread from one area to another.
- Family history – Genetics appears to play a role in developing both conditions.
Shared Symptoms Between Blepharitis and Rosacea
Blepharitis and rosacea also overlap in terms of symptoms, especially around the eyes:
- Red, irritated, swollen eyelids
- Burning, dry or itchy eyes
- Crusting of eyelashes
- Chalazia or styes
- Blurry vision or photophobia
- Visible blood vessels on eyelids
This symptomatic overlap is primarily seen with ocular rosacea. One study found that 58% of patients with ocular rosacea also had blepharitis.
Key Differences Between Blepharitis and Rosacea
While blepharitis and rosacea share some similarities, there are important differences between the two conditions:
| Blepharitis | Rosacea |
|---|---|
| Affects the eyelids | Affects the face |
| Inflammation of the eyelid margins | Inflammation of the skin |
| Can cause dry, gritty feeling in the eyes | Doesn’t directly cause dry eye symptoms |
| Mainly causes eye-related symptoms | Mainly causes facial symptoms like flushing, redness, acne |
| No subtypes | Four subtypes identified |
As this comparison shows, rosacea mainly affects the facial skin while blepharitis specifically affects the eyelids. Blepharitis can directly cause eye irritation while rosacea does not. And only rosacea has defined subtypes.
Blepharitis and Ocular Rosacea
Although rosacea and blepharitis are separate conditions, blepharitis does have a close connection with the ocular rosacea subtype.
Ocular rosacea causes eye symptoms like dryness, burning and irritation. These symptoms are due to inflammation of the eyes and eyelids. Blepharitis also causes inflammation of the eyelids leading to similar eye symptoms.
Studies show that a very high percentage of people with ocular rosacea also have blepharitis:
- One study found 96% of ocular rosacea patients also had blepharitis.
- Another study reported 58% of ocular rosacea patients had blepharitis.
For this reason, blepharitis is considered a complication of ocular rosacea by many researchers. Some even propose that blepharitis could be a precursor to developing ocular rosacea.
Treating Ocular Rosacea and Blepharitis
Because blepharitis and ocular rosacea are so closely linked, treatment often targets both conditions:
- Warm compresses and eyelid scrubs to unclog oil glands and reduce debris, bacteria and mites on eyelashes.
- Antibiotic ointments or oral antibiotics to control bacterial overgrowth.
- Anti-inflammatory eye drops like cyclosporine or lifitegrast to reduce inflammation.
- Oral tetracycline antibiotics or isotretinoin pills, which reduce inflammation systemically.
- Topical treatments like metronidazole gel to reduce mites.
By improving blepharitis, these treatments often relieve symptoms of ocular rosacea as well. This demonstrates how addressing blepharitis is an important part of managing ocular rosacea.
Does Treating Rosacea Help Blepharitis?
Since blepharitis is so common in rosacea, effective treatment of rosacea may also improve associated blepharitis. Reducing facial inflammation and rosacea triggers can potentially decrease inflammation of the eyelids as well.
Common treatments for inflammatory rosacea like erythematotelangiectatic or papulopustular subtypes include:
- Avoiding triggers like sun, spicy food, alcohol
- Gentle skin care and moisturizers
- Topical antibiotics like metronidazole
- Topical brimonidine to reduce redness
- Oral antibiotics like doxycycline or minocycline
- Isotretinoin pills in severe cases
- Laser therapy to treat visible blood vessels
Studies show that successfully managing facial rosacea often improves ocular symptoms and blepharitis as well:
- One study found that 48% of patients had complete resolution of blepharitis after rosacea treatment, while 75% had partial improvement.
- Another study reported a 69% decrease in dry eye symptoms after treating rosacea.
So properly treating rosacea may reduce associated inflammation and symptoms of blepharitis. However, some patients require additional treatments targeted specifically at blepharitis to fully manage eye symptoms.
Should You Treat Blepharitis if You Have Rosacea?
If you have been diagnosed with rosacea, it is wise to be evaluated for blepharitis as well, especially if you have ocular symptoms. As many as 3 in 4 rosacea patients may have blepharitis.
An ophthalmologist can examine your eyelids and eyelashes for signs of inflammation. They may recommend treatments like eyelid scrubs, topical antibiotics or anti-inflammatory drops to get blepharitis under control.
Addressing blepharitis is an important part of managing ocular rosacea. Even if you are treating your rosacea, adding specific blepharitis treatments can provide additional relief for your eyes.
Should You Treat Rosacea if You Have Blepharitis?
If you have chronic blepharitis, be on the lookout for any signs of rosacea as well. Redness, flushing, acne or visible blood vessels on your face may indicate rosacea.
See a dermatologist to get evaluated for rosacea if you notice any facial symptoms. Treating rosacea could help reduce inflammation systemically and improve associated blepharitis.
A combination approach addressing both blepharitis and rosacea is often needed to fully treat eye symptoms. Work with both an ophthalmologist and dermatologist to manage both conditions.
The Bottom Line
Blepharitis and rosacea are distinct conditions, but they are linked in many patients:
- 37-72% of rosacea patients also have blepharitis.
- Blepharitis is especially common in ocular rosacea, affecting up to 96% of patients.
- Shared causes like mites, bacteria and inflammation may lead to both conditions in some people.
- Treating rosacea can help improve associated blepharitis in many cases.
- Treating blepharitis is critical for managing ocular rosacea.
So blepharitis is not technically a form of rosacea. However, managing blepharitis is an important part of treating the ocular subtype of rosacea. A multifaceted approach addressing both conditions is often needed to resolve eye symptoms.