Blepharitis (Child)

Blepharitis is inflammation of the eyelid. It results in swelling of the eyelids, and it is often caused by a bacterial infection or a skin condition. Blepharitis is a common eye condition. There are 2 types:

  • Anterior blepharitis. This occurs where the eyelashes are attached (outside front edge of the eye). 

  • Posterior blepharitis. This affects the inner edge of the eyelid that touches the eyeball.

In addition to swollen eyelids, symptoms of blepharitis can include thick, yellow, dandruff-like scales that stick to the eyelid. There may be oily patches on the eyelid. The eyelashes may be crusted (with dandruff-like scales) when your child wakes up from sleeping. The irritated area may itch. The eyelids may be red. The eyes can be red and burn or sting. The eyes may tear a lot, or they may be dry. Some children can become sensitive to light or have blurred vision. Symptoms of blepharitis can often cause a child to become irritable.

Infected eyelids are treated with good lid hygiene and careful removal of crusts. In severe cases, blepharitis may need to be treated with antibiotics. An episode may take 2 to 8 weeks to go away.

Causes

Other causes of blepharitis may include:

  • Problems with the oil glands in the eyelid (meibomian glands)

  • Dandruff of the scalp and eyebrows (seborrheic dermatitis)

  • Acne rosacea (a skin condition that causes redness of the face)

  • Eyelash mites (tiny organisms in the eyelash follicles)

  • Allergic reactions to cosmetics or medicines

Home care

Medicine: You may be given an antibiotic eye drops or ointment, artificial tears, and/or steroid eye drops to treat your child’s infection. Follow all instructions for giving this medicine to your child. If your child has pain, you can give him or her pain medicine as advised by the healthcare provider. Don’t give your child aspirin. Aspirin can cause rare but very serious problems in children. Don’t give your child any medicine for this condition without first asking his or her healthcare provider.

  • Using eye drops. Apply drops in the corner of the eye where the eyelid meets the nose. The drops will pool in this area. When your child blinks or opens his or her eyelid, the drops will flow into the eye. Use the exact number of drops prescribed. Be careful not to touch the eye or eyelashes with the dropper.

  • Using ointment. If both drops and ointment are prescribed, give the drops first. Wait 3 minutes, then apply the ointment. Doing this will give each drug medicine time to work. To apply the ointment, start by gently pulling down the lower lid. Place a thin line of ointment along the inside of the lid. Begin at the nose and move outward. Close the lid. Wipe away excess medicine from the nose area outward. This is to keep the eyes as clean as possible. Have your child keep the eye closed for 1 or 2 minutes so the medicine has time to coat the eye. Eye ointment may cause blurry vision. This is normal. Apply ointment right before your child goes to sleep. In infants, the ointment may be easier to apply while your child is sleeping.

General care

  • Wash your hands carefully with soap and warm water before and after caring for your child’s eyes.

  • Apply a warm compress or a warm moist washcloth to your child's eyelids for at least 1 minute, 2 to 4 times a day. Then wipe away scales or crust from the eyelids.

  • After applying the warm compress, gently scrub the base of your child's eyelashes for almost 15 seconds per eyelid. Do this with your child’s eyes closed, using a moist eyelid cleansing wipe, clean washcloth, or cotton swab. Ask your child's healthcare provider about products (such as nonirritating baby shampoo) to use to help clean the eyelids.

  • You may be instructed to gently massage your child's eyelids to help unblock eyelid glands. Follow all instructions given by the healthcare provider.

  • Clean the eyelid if it has a lot of crusts. Use warm water and a small amount of mild baby shampoo (about a 1//2 teaspoon to one 1 cup of warm water), or an eyelid scrub recommended by your child’s healthcare provider. Put the solution on a clean washcloth or gauze pad. Gently clean the lashes and lid edges. Don’t touch the eye. Be gentle to avoid causing irritation. Carefully rinse if shampoo is used.

  • Try to prevent your child from rubbing his or her eyes.

  • Unless told otherwise, regularly clean your child's eyelids (while they are closed) as directed by the healthcare provider. Blepharitis can be an ongoing problem.

  • As applicable, your child should not wear eye makeup until the inflammation goes away, or as directed by your healthcare provider.

  • As applicable, your child should not wear contact lenses until he or she completes treatment.

  • Encourage your child to wash his or her hands regularly. This helps to reduce the chance of dirt and bacteria coming in contact with the eyelid.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. Blepharitis requires regular follow-up. Your child may be referred to see a healthcare provider who specializes in treating eyes (an optometrist or ophthalmologist) for further evaluation and treatment.

When to seek medical advice

If your child is usually healthy, call his or her healthcare provider right away if any of these occur:

  • has a fever (see “Fever and children” below)

  • Symptoms get worse.

  • Your child has eye pain.

  • Redness increases in the white part of the eye.

  • Your child has a change in vision (trouble seeing or blurring).

  • The eyelids start draining pus or blood.

  • Swelling, redness, irritation, or pain of the eyelids gets worse.

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead, or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit (axillary) temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

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