Best Eye Treatments for Blepharitis and Ocular Rosacea

Around 2016 I found out I have blepharitis stemming from ocular rosacea.  For years I’ve wondered why my eyes were often red, dry, and irritated looking.

Visine would temporarily give me a boost but after about 5 hours I would experience rebound redness which is even worse!

We all want those beautiful, bright white eyes. After all, your eyes are the first thing that anyone looks at when they meet you!

At first I thought maybe it was allergies, since I test so many beauty products to write about them, but my Dr. assured me it was not allergies (at least there’s that silver lining).

I decided to write about this because I know that many people probably suffer from this condition, and I wanted to share the eye cleansing routine that works for me, and some other helpful tips from my routine.

What is Blepharitis?

If you’ve found this post, you probably already know what blepharitis is, but in case you don’t, I’ll explain.

Blepharitis (Mayo Clinic link) is a common and ongoing condition where the eyelids become inflamed with oily particles and bacteria coating the eyelid margin near the base of the eyelashes.

Blepharitis can cause redness and irritation, and stinging or burning of the eyes. My main symptoms have been red eyes and dryness of the eyes, and eyelid irritation along my lower lashes.

My Dr. determined that I have “posterior blepharitis” which is a dysfunction of the eye’s tiny oil glands in the eyelids at the base of the eyelashes where they often get blocked. Those tiny glands are called meibomian glands and the term MGD means meibomian gland dysfunction.

Basically, he said that my oil to tear ratio is off which causes the irritation. When the oil glands are blocked, your eye is not getting the proper lubrication. This is why hot eye compresses to get the blocked oil glands flowing again is very helpful. 

What is Ocular Rosacea?

Ocular Rosacea (see Cleveland Clinic link) can lead to blepharitis, and for me this seems to be the culprit.

Ocular rosacea often develops in people who have rosacea, and sometimes ocular rosacea is the first sign that you may later develop the facial type.

I’ve since been told by my eye Dr. that I do have signs of rosacea in my skin, which makes sense because I’ve always had  pinkness in my skin and it gets red easily with the wrong products, or even from hot yoga.

What Helps Blepharitis and Ocular Rosacea?

So now for the fun part!

If you have blepharitis or ocular rosacea – how do you mitigate those symptoms so you can put your BEST face forward?

You can  improve your symptoms greatly, but it takes commitment to a daily eyelid hygiene routine at minimum. This list comes from a LOT of trial and error and many trips to the eye doc!

Eye Lid Cleansing Routine

• Daily hot compresses with a washcloth on your eyes both morning and night, for about 2-3 minutes. If you get to a point where it’s a lot better, you can try just doing them at night time.
• Wash eyelids (not the inside of the eye, just the top and bottom lids and eye margins) with Johnson’s baby shampoo (or Aquaphor baby wash) mixed with a little water. I use clean fingers and also q-tips to rub the lash lines gently. Use a new q-tip for each eye.
• You can opt to use a lid scrub instead of baby shampoo to cleanse the lids. These are small square pads with cleaning solution already on them. Use a gentle circular motion and really get into the lash line. I really do prefer using the Ocu Soft pads but they are pricier than baby shampoo. They are just made for eyes so ultimately the most gentle in my opinion.
• If you wear makeup, use makeup remover first with a cotton pad before the eye cleansing routine or you will never get all the mascara off, which is a huge culprit for bacteria growth. I use the Garnier Micellar Cleansing Water. 

Moisture Drops

• Use the preservative free moisture drops 1-2x a day or as needed (the ones in the individual droppers with no preservatives).
• I’ve been using Refresh Optive Advanced. I did try the bottle type (which is cheaper but has preservatives) and it made my eyes sting, so I won’t use those anymore.
• Stop and blink 20 times quickly every hour! This helps coat the eyelids and keep them balanced. If you’re staring at a computer screen all day, this is especially helpful.

Supplements to Reduce Inflammation

• Take 2000-3000 mg per day of Omega 3 fish oil. I take the Nordic Naturals Ultimate Omega which I’ve seen in most grocery stores. Fish oil helps reduce inflammation but it can take a few months to take effect, so be patient (and know that there are a TON of other health benefits of supplementing with Omega 3’s).
• Flax Seed Oil or Ground Flax Seed – this is also a good way to get Omega 3. I  love putting a tablespoon of each in my morning smoothie. I like the Spectrum ground flax seed, and Barlean’s flax seed oil. I’ve settled into just using the ground flax because I like the nutty texture in my smoothie. Walnuts and chia are also great sources.
• I use MCT oil in my coffee each morning.  MCT is a coconut oil extract and it helps my overall condition (and has other benefits as well). MCT is said to be the world’s healthiest fat source.
• Salmon is a great source of Omega 3’s and I usually eat it twice per week. Sardines, oysters, and mackeral are also great sources, but yuck. 😉

Eye Cream for Sensitive Eyes

Having blepharitis made me question the anti-aging products that I use on my eyes. Obviously I don’t use products that are going to irritate my already sensitive eyes. Like my eyes are hella sensitive, and they do get dry from the hot compresses.

I’ve been using the Beautycounter Countermatch Eye Rescue Cream, which contains no irritating chemicals and doesn’t irritate my eyes at all.

I use it both under my eyes and right on my eyelids. Beautycounter products are very calming, soothing and non irritating with no harmful chemicals.

I love clean beauty and try to avoid unnecessary chemicals, especially in my beauty routine with these eyeballs of mine!

*UPDATE*

Ok, so this is a super annoying condition! My eyes got a lot better for a while, I followed the routine above, and then got slack after about six months. Boy was that a mistake! I think I had my worst flare up ever. I want new eyeballs!!! 😉

I’ve learned that with this condition, you can’t ease up on anything. It’s chronic and there is no cure. You just have to keep your symptoms in check and learn what your triggers are. But sometimes you may need some help by way of RX meds.

I’m back on a strict routine and have gotten things under control but there are some things my Dr. added that you may find beneficial. This was a NEW Dr. and I’m so glad I switched. 

Meibomian Gland Expression – He put numbing drops in my eyes and used a tool to squeeze the lower lash line to express the blocked glands. He said it was thick and came out like toothpaste – super gross. At least he got the oil glands “unplugged.”

Lotemax Steroid Drops…this has been a Godsend but I know I can’t use it forever since it’s a steroid. It has made my eyes whiter than they have been in a very long time. During my flareup, I used 2x day for a couple weeks, now I’m at once per day in the morning (typically only use 2-3x week now). Steroids reduce inflammation immediately.

Azasite 1% Azithromycin Eye Drops – I used this at night along my lower lids for a couple weeks during my flare up. At first it was a bit stingy so I would just put some on a qtip and gently apply to my inner lower lids. Now I can just pull my lower lid back and put a drop in. I like to do this JUST before bed, so I can just close my eyes. This will help fight infection which can all be a part of this blepharitis condition (bacteria builds up in those glands since they’re not flowing properly). During my flare up I used every night for a week, dropped down  to 3-4 nights per week and did this for about a month, then stopped.

Now, I use Moxifloxacin – my Dr. says I can use this “as needed” and says “I’ll know” when I need it. I can definitely tell when my eyes get a little cranky. He said using it a couple times per week will keep the bacteria at bay and that it’s safe to use ongoing (since normally you build tolerance to antibiotics, but using it sparingly he says it’s OK). So, ask your Dr. what drops are best for you.

Eyelid self massage – After doing the warm/hot compresses, gently massage your eyelids and push up underneath your eye towards your inner lid, and do the same on the top. Rub downwards. This will help express the clogged oil in your glands. You won’t “see” it coming out, so be very gentle.

Face Steamer – I bought a Conair face steamer from Macy’s, you know – the old school ones! Sometimes I’ll do this instead of hot compresses. This will open up your meibomian glands and is great for your skin as well. I flutter my eyelids open and shut during the process. I also put a towel over my head to trap the steam in. Once you’re done steaming, you can do the eyelid massage. Once you’ve done that, be sure and use your eye wash pads (or baby wash) to cleanse your eyes as the massage and steaming will make the goop form in your eyeballs sometimes.

Makeup Changes – I actually quit wearing eye makeup for a whole week when I started this new regimen. If you’re having a bad flare up – give yourself a break from makeup. Also when it comes to mascara, I’ve always used expensive brands like Mac or Benefit.  Mascara is the worst culprit to spread bacteria around your eyes. Now I buy a cheaper one and replace it every month. The three I like best are Loreal, Almay, or Clinique (if I want to splurge).  Don’t ever wear eyeliner on the inside water line of your eye, you don’t want to layer on makeup RIGHT over your meibomian glands if you have problem eyes.

Pillow cases – Wash them twice per week, bacteria builds up on pillow cases quickly.

Eye Mask To Sleep – My husband sleeps with the overhead fan on and a small table fan (yes, two *facepalm*) so the air flow was killing me. I bought one of those masks from BBB that has the concave eyes so it doesn’t touch your eyelashes. This helped my eyes from drying out over night. Sometimes I would wake up and could hardly blink because they were so dry!! (For the record, once I was over my flare up and my eye glands were flowing a bit better, I found I didn’t need the mask, but in a flare up it might be beneficial).

Humidifier – I bought a small humidifier from BBB and keep it next to my bed and sometimes leave it on low during the night. I did this for a few weeks, but it didn’t seem to make much difference so I stopped doing it. But if you live in a very cold, dry climate I think it would help.

Eye drops next to bed – First thing I do now when I wake up is put a drop of the Refresh Advanced Optive (the single use ones) in my eyes to freshen them up. They are always the most dry when I wake up.

Anti-inflammatory diet – I’ve tried two ways of eating that have helped me the most. One is a keto diet (or keto’ish) and the other is just going gluten free and dairy free (I find doing either keeps me away from inflammatory foods). Dr.’s say that blepharitis is a chronic condition that you can’t cure, but you can certainly help it with diet.

If you reduce the inflammation in your body, you’re going to have less inflammation in your eyes, and rosacea is inflammation. Learning your food triggers (like alcohol, spicy foods, gluten, dairy, etc) can help tremendously.

There is a supplement I’ve been taking called Keto OS which is exogenous ketones drink that puts your body into ketosis which is exactly what the ketogenic diet does, but without having to follow a strict keto diet.  I use the MCT oil in my coffee in the mornings, and drink one Keto Nat per day in the afternoon. It also keeps me slim so it’s a win-win!

Whitening Eye Drops

Ok so we know that Visine is a no-no when it comes to blepharitis, but if I have a special event like a wedding, or even a date night, and I want my eyes to really pop, I use Lumify by Bausch & Lomb, which you can buy at the grocery store or drug store.

It’s pricey, about $25 but it works like a dream, and was recommended by my eye Dr. and I don’t get the rebound redness, so hooray!

Here’s a recent picture of me heading out to a 40th birthday party. My eyes are NEVER this white naturally, but it is so nice to be able to use these drops for special occasions! My sister also uses these drops for her brides! (she’s a makeup artist, so it’s a bit of a trade secret).

Final Thoughts

If you’ve gotten this far, that means you’re likely suffering from blepharitis, and I’m so sorry because I know how frustrating it can be. But if you follow some of these tips I’ve given, I am confident you will see an improvement!

And I know this is a LOT to digest… just start with the cleansing routine and natural remedies and see if that helps, but if you’re really not getting anywhere, please see your doctor and get some prescription eye drops.

Do you have blepharitis? I would love to hear about the treatments that work for you, leave comments below!

Q: Hi!
How long did it take to go away?
I was diagnosed with blepharitis first. Did warm compresses and lid scrubs. Got second opinion. Told it was ocular rosacea. Again, like yourself, never knew I had rosacea. Still doing warm compresses and lid scrubs but this has been going on since July, and I’m feeling pretty hopeless.
Thanks! –Ursula

A: Hi Ursula, thanks for your question. This is a frustrating condition! I’ve gotten pretty good at keeping mine under control by sticking with my routine.  The daily hot compresses and using those moisture drops are key, and using a gentle cleanser or the baby shampoo.  I wash my face daily with a washcloth so I just spend a minute extra doing the warm compresses, and again at night. Never go to bed with any eye makeup on. My eyes still get a little red sometimes but not as bad as before. I never, ever use visine anymore because that makes it worse. Rebound redness. I also have to be careful which makeup I use. Mac eyeshadow, eyeliner and mascara don’t bother me in neutral colors.  If I run out of drops for a day or two, I really start feeling it. Gotta keep using them twice a day. My eyes are never bright white, but the redness from my initial flare up has gone down. I didn’t like the lid scrubs personally, I prefer the baby shampoo or I can use my Lifecell facewash right on my eyes since it’s very gentle. Good luck! Rachel

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Q: Wondering what Omega 3 capsules would be good for blepharitis. –Karen

A: Karen, if you don’t like the sounds of the Barlean’s Swirl I mentioned in my blog post, they also make capsules. I have both because I don’t always feel like making a smoothie. You can find at Whole Foods or online I’m sure. Rachel

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Q: You state that “Basically, he said that my eyes overproduce oils and under-produce tears. Not a good combination,…”. I was told the exact opposite, that my eyes over produce tears (which are drying) and under produce oil. My oil glands get clogged, which causes the oil to accumulate in the lids. This causes the swelling in the lids and eventually the oil glands respond by underproducing. TY for the info! –Jill

A: Hi Jill, blepharitis is a huge pain in the butt! I went from a Stage 3 (bad) blepharitis to a Stage 1 in about one month following all the things I said I was doing in my review. It’s tedious but it works! Many of my oil glands went from being clogged to open. The hot compresses and lid massage are key, and for me so is the Lotemax for inflammation. Also eating a ketogenic diet has helped tremendously since it’s an anti-inflammatory diet, plus you lose weight;) Good luck, this is not a fun condition. I don’t even wear makeup on my lower lids any more AT ALL, not even mascara. Rachel

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Q: Where did you find the aquaphor baby wash and shampoo? I have both eye conditions and my Mom had both conditions for years before she passed away. –Cindy

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Q: I have blephritis. I do lid scrubs with baby shampoo and warm compresses. I have it as under control as possible but still have a little bit of (bags) Thinking of blepharoplasty but scared that since I have blephritis the bags won’t go away anyway. Can anyone help?? –Samantha

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