Seborrheic dermatitis of the eyelids (sometimes called eyelash dandruff) often accompanies general seborrheic dermatitis (at other areas of the skin) and can be an annoying condition to treat. In most cases, the condition can be quite persistent and undergo phases of improvement and worsening.
The main symptoms of the condition include:
- Inflamed and red eyelids
- Crusting and flaking deposits at they eyelids and on the eyelashes
- Eye irritation, dryness and itchiness
This article attempts to provide a general discussion of the condition and reviews some of the more common treatment approaches. Things you will learn include:
- Different forms of inflammatory skin conditions affecting the eyelids
- What makes of seborrheic dermatitis of the eyelids unique
- Particular characteristics of the eyelids that can make them difficult to treat
- What treatment approaches currently exist and what’s on the horizon
Hope you find the article useful and if you have any question or suggestions regarding any of the information presented, would love to hear from you in the comments section at the end.
Seborrheic dermatitis of the eyelids or dandruff of the eyelashes?
The two terms (seborrheic dermatitis and dandruff ) appear to be used interchangeably and this can create a lot of confusion. Though there is some disagreement, many researchers describe dandruff as a mild form of seborrheic dermatitis with only limited inflammation.
Table of Contents
- 1 Quick Recap of Main Factors of Seborrheic Dermatitis
- 2 Is It Eyelid Seborrheic Dermatitis, Eyelash Dandruff or Seborrheic Blepharitis
- 3 Why The Eyelids are A Difficult Area to Treat and Some Considerations
- 4 Some Important Aspects of Seborrheic Blepharitis
- 5 Finding an Optimal Treatment Approach for Seborrheic Dermatitis of the Eyelids (Seborrheic Blepharitis)
- 6 Conclusion
Quick Recap of Main Factors of Seborrheic Dermatitis
Seborrheic dermatitis is a inflammatory skin condition affecting an estimated 3% of the general population. It remains not fully understood and there does not appear to be an universally applicable treatment approach.
Let’s consider some key points regarding seborrheic dermatitis:
- Seborrheic dermatitis is an inflammatory skin condition that relates to the sebaceous glands
- Malassezia yeasts are most commonly blamed for much of the symptoms
- The most common understanding is that the malassezia yeast feed on the lipids found in our sebum, producing by-products which are responsible for the undesirable symptoms
- Topical anti-fungals are the main dermatological treatment currently prescribed, as they reduce malassezia activity and prevent the production of symptom causing by-products
In review, it seems that sebum is an important component of the seborrheic dermatitis cycle. Without it, the malassezia yeast would not have the resources they need to produce the specific by-products which cause the symptoms collectively known as seborrheic dermatitis.
The eyelids themselves do not have sebaceous glands, but instead have meibomian glands. These glands produce a special type of sebum (known as meibum), also rich in lipids. Thus, since the eyelids do have a potential lipid source for the malassezia yeast, the eyelids are in-fact prone to seborrheic dermatitis issues.
Is It Eyelid Seborrheic Dermatitis, Eyelash Dandruff or Seborrheic Blepharitis
Dandruff is described as a condition affecting the scalp, characterized by itching, flaking and dryness of the scalp. Since the definition of the condition specifically indicates the scalp as the affected area, we can presume eyelash dandruff is an incorrect diagnosis.
The word dermatitis on the other hand, is a general medical term which means “inflammation of the skin”. Add on seborrheic, and it then describes sebaceous gland related inflammation of the skin. This is getting closer, but there exists a more accurate term.
The word blepharitis is a medical term which describes the “inflammation of the eyelids”. As a result, if we are discussing seborrheic dermatitis of the eyelids, we are really talking about seborrheic blepharitis.
You may think that these are just technical words and the condition is still the same, but knowing this differentiation is important to figuring out weather or not your actually dealing with seborrheic blepharitis.
Four Main Types of Blepharitis
Similar to dermatitis, blepharitis comes in various forms. The four most common forms are (1):
- Staphylococcal blepharitis
- Seborrheic blepharitis
- Posterior blepharitis (Meibomian gland dysfunction)
- Demodex blepharitis
Though there is some overlap between them, individuals are typically affected primarily by one of these types of blepharitis.
Figuring Out Weather or Not Your Affected by Seborrheic Blepharitis
- Greasy eyelid and eyelash crusting (as opposed to overly dry)
- Significant amount of inflammation
- Accompanying, seborrheic dermatitis
Most important of these appears to be that seborrheic blepharitis is the most common type of blepharitis in those individuals affected by seborrheic dermatitis (on other areas of the skin). This means that if you have seborrheic dermatitis on areas of your facial skin, chest or have excessive dandruff and your facing issues on the eyelids/eyelashes, it’s very likely that it’s seborrheic blepharitis.
Why It’s Important to Treat Seborrheic Blepharitis Promptly
One of the most invasive features of seborrheic blepharitis is that it often blocks the meibomian glands (eyelid’s version of the sebaceous glands), resulting in reduce eyelid sections.
Adequate eyelid secretions are very important for eye health and if blepharitis is left untreated for an extended duration, ocular damage may result and eyesight may be affected. For example, one study noted that corneal erosions in approximately 15% of examined individuals affected by seborrheic blepharitis (4).
Unfortunately, blepharitis is often noted as being a chronic condition which does not appear to have any single uniformly successful treatment. Instead, most of the literature suggests that ongoing treatment is recommend to reduce symptoms and improve regular eyelid secretions.
Thus, finding workable treatment approach promptly greatly reduces the chance of any unwanted secondary issues.
Why The Eyelids are A Difficult Area to Treat and Some Considerations
The eyelids and eyelashes, in such proximity to the eye and the sensitive cornea, make finding an effective treatment solution (mild enough for this sensitive area) tricky. If at other areas of the skin we have the luxury of attempting treatments such as tea tree oil or astringent ointments, their usage on the sensitive skin of the eyelids can cause significant irritation and result in more harm than good.
As a result, it may be helpful to review the specific limitations such a sensitive area of skin can present and narrow down the amount of treatment candidates considered.
For reference, here are items which you may want to avoid when it comes to usage on the eyelids:
- Formulation with strong fragrances or volatile oils (essential oils)
- Strong acids or highly alkaline solutions
- Non-prescribed anti-fungal or antibiotic preparations
- Coal tar or other forms of tar
- Sulfur preparations
However, keep in mind that this list is not set in stone and different individuals appear to have varying tolerance levels for treatments.
Some Important Aspects of Seborrheic Blepharitis
Before discussing possible treatments, it may be worthwhile it quickly review what happens when our eyelids (and eyelashes) are affected by seborrheic blepharitis.
- Abnormal lid margin secretions
- Altered presence of lid margin bacteria and/or fungi
- Dysfunctional precorneal tear film (thin film layer covering the eye)
- Increase inflammation of the meibomian glands and eyelash follicles
As the secretions are altered, microbial/fungal colonization is more pronounced, further influencing the secretion composition. This leads to a reduction of lipids (oils) available for moisture retention required by a healthy tear film; leading to dryness and pronounced itchiness.
Taken together, these factors create a cycle which feeds on itself and can be difficult to break.
What are flakes/crusts on the eyelids and eyelashes?
Interestingly, the crusting seen in blepharitis is primarily lipids and wax which have hardened. Some papers note that this is likely caused by a higher concentration of saturated fatty acids which become solid at body temperature (9, 10).
Finding an Optimal Treatment Approach for Seborrheic Dermatitis of the Eyelids (Seborrheic Blepharitis)
The following section provides several methods most commonly discussed throughout the medical literature. The most common of which include (11):
- Warm compresses – help restore normal eyelid secretions and melt off crusting
- Eyelid and eyelash cleansing – removes build up and helps restore normal secretions
- Antibiotics and antifungals – reduce the microbial/fungal colonization and restore flora balance
- Steroids – modulate inflammation and control symptoms, but long term usage should be avoided
- Calcineurin inhibitors – down-regulate the immune response and may inhibit the inflammation cycle
- Omega 3 supplementation – reduce inflammation and possibly improve secretion composition, but need extended time period to show effectiveness
In addition to these, there are also various treatment options currently in development which use things such as heat and pulsated light to restore normal eyelid secretions (12), but these are still in their early phases and will not be discussed here.
Proper diagnosis should always be the first step
Please remember that consultation with a local medical professional is always recommended. Proper diagnosis of the specific type of blepharitis is a crucial step and may actually be the most important part of treatment.
Warm Eyelid Compresses
Applying a warm water compress to the eyelid and eyelashes using a cotton swab or pad is a method practiced regularly throughout the clinic context.
The basics of this approach are as follows (13):
- Boil water and allow to cool to a moderate temperature
- Soak a clean cotton pad or washcloth in the water
- Apply the compress to the eye for 5-10 minutes (use new pad/washcloth each time)
This can be done multiple times in a day (spaced out) and should help ease many of the unfavorable symptoms. As things improve, a more spaced maintenance schedule can be beneficial.
The goal of this treatment approach is to remove much of the symptom causing build-up and assist normal secretions. Though it does appear to be fairly effective, symptoms typically return.
Adding in an eyelid massage
Though a massage of the eyelid is often recommended to follow the compresses, it appears to have little effect on improving the blepharitis itself, but more-so on the accompanying (eye related) symptoms. However, too much massaging is never recommended as it can lead to irritation and worsening of symptoms (14).
Regular Practice of Eyelid and Eyelash Hygiene
Due to the limitations of warm compresses, many companies have made attempts to produce standardized eyelid cleaning solutions; primarily in the form of gentle cleansers specifically designed for the eyelid area.
Though these cleansers have shown some potential in small scale studies, there does not appear to be any universally recommended solutions. Because of this, a simple and more widely accepted eyelid cleansing approach is provided.
The basics of this approach are as follows (15):
- Dissolve a heaped teaspoon of salt or sodium bicarbonate in 500ml of boiled water
- Allow solution to cool to an acceptable temperature
- Using clean cotton swabs and pads (discard after each wipe), clean the eyelids and eyelashes
And more details of this approach are accessible on the following page:
Community Eye Health – How to Clean Eyelids
Some studies suggest using a baby shampoo
Several papers make reference to using a baby shampoo to clean the eyelid and eyelash area to improve removal of build-up (16, 17) . However, baby shampoos typically have a low pH and this is considered by many an unfavorable factor for skin barrier function (18).
Antibiotics and Antifungals
Since many of the issues seen in blepharitis are often associated with a microbial/fungal imbalance, treating the eyelids with an antimicrobial or antifungal solution is one of the more direct and effective treatment options.
In general, this treatment category seems to produce the quickest and most efficient results. But since there is so much variation in the solutions available, consultation with a local physician is necessary to ensure you get the most appropriate formulation for your specific issue.
Solutions containing mild corticosteroids (such as hydrocortisone or dexamethasone) are often prescribed for the treatment of various forms of blepharitis (including seborrheic blepharitis) (19). The main mode of actions of these solutions is to reduce the local inflammation of the area and this cause a quick relief of many of the common symptoms.
The issue with this approach is that steroid usage on the sensitive skin of the eyelids has many possible complications. Part of these complications is attributed to the ability of topical steroids to thin the skin (atrophy) and this effect is further amplified by the already thin skin of the eyelids.
Other possible complications of corticosteroid usage on the eyelids and eyelashes include:
- Increased intraocular (fluid inside the eye) pressure
- Corneal and lens changes
Because of these possible complications, the usage of corticosteroids on the eyelids, eyelashes and around the eyes should be closely monitored and only permitted for short durations.
In the end, you should definitely consult with a medical professional regarding this treatment approach and avoid self-direct treatment.
Calcineurin inhibitors, literally do what they say, they block the chemical by the name of calcineurin, which is an integral component of skin inflammation.
Similar to topical corticosteroids, they modulate the immune response and reduce inflammation, leading to a reduction in symptoms. As symptoms improve, they eyelid secretions get a chance to stabilize and return to normal function.
The most common types of calcineurin inhibitors are:
- Tacrolimus ointment
- Pimecrolimus cream
And for the most part, they do not appear to have the possible negative complications associated with corticosteroids (thinning or increased pressure within the eye) (20).
However, you should definitely consult with your medical professional if considering this treatment approach as it does still have possible complications (21), requires a prescription and should be evaluated for applicability.
Omega 3 Supplementation
Omega 3 fatty acids have been shown by numerous studies to have a significant ability to reduce systemic inflammation and stabilize overall immune function (22).
When evaluated for the treatment of chronic blepharitis, they have shown some potentially promising results. For example, in individuals undergoing a one year treatment period showed the following improvements (23):
- Improved eyelid secretion composition – in a portion of the participants
- Reduce eyelid inflammation and reduction in overall symptoms – in a portion of the participants
- Higher blood levels of omega 3 fatty acids
- Improved overall ratio of omega 3 to 6 fatty acids
But the amount of time required for this approach to show results, the limited study size and the not fully understood differences in eyelid secretion composition improvements leave lots of room for speculation.
Nonetheless, the importance of the omega fatty acid ratio in health disease is something many of us underestimate and a good understanding of this topic may be beneficial to practically anyone (especially, if your also dealing with seborrheic dermatitis and other inflammatory health conditions).
Chronic conditions need long term approaches
It is my belief that if faced with a chronic issues which keep relapsing, the immune system likely needs some attention and a long term approach should not favor immediacy.
In tandem with treatment, the following considerations may prove useful at reducing the treatment duration and improving the long term outcome:
- Cosmetics should be avoided during flare ups as they can worsen inflammation, induce irritation and prevent clearance of debris from the lid margin
- When using cotton swab or tips for cleaning, they should be discarded after each use/wipe
- Be careful with home remedies for the treatment of seborrheic blepharitis, as many suggestions seen online may result in unnecessary introduction of unwanted substances and further worsen symptoms
- It seems that resolving seborrheic dermatitis at other areas of the skin can improve eyelid symptoms indirectly, as the overall load decreases.
- Demodex mite infestation into the eyelash follicles can at times mimic the symptoms of seborrheic blepharitis, but treatment differs significantly and this condition often accompanying rosacea (as opposed to seborrheic dermatitis) (24)
These tips will likely be updated and expanded with time and based on discussions/questions in the comments section.
This article attempted to provide an in-depth overview of seborrheic blepharitis (also referred to as seborrheic dermatitis of the eyelids and/or eyelash dandruff) and discussed some possible treatment approaches.
The main takeaways include:
- Seborrheic dermatitis of the eyelids (or eyelash dandruff) goes by the name “seborrheic blepharitis”, which features unique characteristics as compared to other areas of the skin
- There are several other types of blepharitis (inflammatory eyelid conditions) with similar symptoms and accurate diagnosis is the first step to treatment
- The most common symptoms specific to seborrheic blepharitis include greasy eyelid/eyelash crusting, significant inflammation and the coexistence of seborrheic dermatitis at other areas
- Prompt treatment is recommended to reduce the chances of secondary issues (fairly rare) which can effect eye health and vision
- Due to the already thin skin of the eyelids and the close proximity to the eyes, many potential treatment options (such as corticosteroids and strong topical) become troublesome
- Improving eyelid secretions by physical removal of build-up is a good starting point, but controlling the microbial/fungal activity is likely to produce the most pronounced results
- Due to the large variation of possible micro-organisms that may be playing a role in your symptoms, consultation with a local medical professional is highly recommended
- Because of the relapsing nature of the condition, omega 3 supplements and simple eyelid hygiene practices are likely to reduce the frequency and intensity of future flare ups
If you would like to discuss any of the topics above, share your own experience, have suggestions, or any questions, you can join the discussion in the comments section below.
In the end, hope you’ve found the information provided in this article relevant and the discussion of the various treatments of seborrheic blepharitis (aka seborrheic dermatitis of the eyelids and/or eyelash dandruff) helpful.
This post is also available in: Deutsch (German)