Picture one of those typical doctor intake forms. Would you check a box beside any of these?

• Red, scaly, crusty eyelids
• Flaky debris along the lashes
• Frequent and recurring styes or inturned eyelashes
• Chronic redness, itching, watering, or irritation

If you answered yes to any of the above, you likely have blepharitis.  Blepharitis simply translates as inflammation of the eyelid skin, but it's commonly associated with conditions like ocular rosacea and dry eye syndrome. And it's extremely common - studies suggest as many 47% of all patients that are seen by an eye doctor have some degree of blepharitis.

Blepharitis caused by Demodex colonies have a classic appearance of cylindrical dandruff or collarettes along the base of the lash root. via

For decades the go-to treatment recommendation for chronic blepharitis was eyelid hygiene with baby shampoo. The concept? The most common causes for blepharitis are skin bacteria like Staphylococcus epidermis and Staphylococcus aureus or eyelid mites Demodex brevis and Demodex folliculorum. These strains of bacteria are found naturally on human skin, and Demodex mites are also extremely common: studies confirm 70% of 18 year olds have Demodex mites living on their facial skin and over 84% of healthy adults over 60 have mites.  Both skin bacteria and Demodex colonies thrive when there are more dry skin flakes and skin oils hanging around the eyelid surface, growing rapidly and often causing chronic irritation as their populations explode.  It's a dangerous feedback circle: the more the body inflames in response to bacterial growth or Demodex infestation, the more it sheds the surface layers of skin, giving bacteria and mites more of what they love to live on. 

Microscopic view of demodex mites at the base of hair and eyelash follicles via

Getting rid of dry skin and abundant skin oils is essential to minimizing the habitat for bacteria or Demodex, so doctors historically turned to baby shampoo as a "no tears" way to clean the sensitive eyelid area.  The issue with baby shampoo is that the detergents and preservatives found within can actually promote skin irritation. Preservatives in baby shampoo like quaternium-15 chemically release formaldehyde, a known skin and eye irritant.  Some research suggests that baby shampoo can interact with the eyelid's natural oil expression (meibum), turning it into a pro-inflammatory soap-like expression that is irritating to the eye and eyelid, a process called saponification. 

A Better Alternative?
OCuSOFT lid cleansing products have the cleansing power to knock out skin bacteria and Demodex colonies, but are far more gentle and less irritating to the delicate eyelid skin than baby shampoo. Studies assessing ocular irritation on OCuSOFT products found that OCuSOFT Lid Scrub Plus was "practically non-irritating" to the ocular surface if not rinsed off in 1 hour based on Draize score data. Baby shampoo was rated category 3 or "mild irritation" on LVET (low volume eye test) Draize testing. OCuSOFT products are graded as 16 x milder than baby shampoo for eye irritation!




Not only were OCuSOFT products found to be more comfortable to the eye than baby shampoo, they also have significantly better bacterial kill rates. Studies on skin wound cleansing scored Johnson and Johnson Baby Shampoo as non-antibacterial at 24 hours against Staph. aureus at "cell-safe" levels, and additionally scored it with a high cytotoxicity index score (meaning it was considered highly irritating and damaging to healthy cells as well). OCuSOFT Plus lid scrubs have exceptional kill rates against common skin bacteria that are known causes of blepharitis, including Staph. epidermis, Staph. aureus, and even MRSA. 



Our recommendation? For chronic blepharitis put down the baby shampoo and reach for a specific eyelid hygiene product. In my personal practice I recommend daily use of OCuSOFT Lid Scrub Plus for bacterial-based blepharitis until the eyelid inflammation is controlled, and then recommend use of daily lid cleansing products like OCuSOFT Original pads or foam longterm to help promote a skin environment that would be inhospitable to bacteria or Demodex infestation. Eyelid hygiene is part of my patients' everyday routine for clear vision and healthy eyes; you can't take a night off from caring for your eyes and delicate eyelid skin and expect your eyes to perform at their best level. OCuSOFT is gentle enough to be used as a daily cleanser for even sensitive skin types, and its strong enough to neutralize skin bacteria and help prevent chronic conditions like blepharitis and recurrent styes. 

Wanting to learn more about all the products in OCuSOFT's line of lid cleansers? Head here

OCuSOFT is a platinum sponsor for Eyedolatry but all opinions are my own.

For many people, having a stye is just a one time issue -- maybe you slept in your eye makeup one night, or just didn't wash around your eyes well after being exposed to a dirty environment.  But for some people, the chemistry of their skin and eyelid oil glands (Meibomian glands, glands of Zeiss, or glands of Moll) make styes a regular occurrence.  Here is how to fight back if you fall into the latter category.

Warm Massage
One of the best things you can do to combat styes is apply heat.  Every night take a hot wash cloth and gently massage the eyelash root area, both top and bottom eyelid.  The heat will open the oil glands, and help encourage release of any hardened glad secretion that would otherwise clog.  You are also removing the day's bacteria and dry skin from the area, decreasing your chance of infection. Try to do this every night: just a hot washcloth massage for 30 seconds at the eyelash base of both top and bottom eyelids.

Eyelid Cleansers
If you need more intensive help than just a warm cloth, you can't go wrong with Ocusoft's eyelid cleansing products.  The pad or pump bottle foam options are both great at cutting down bacteria and dry skin.  In many cases this product alone can solve issues ranging from recurrent styes to itchy and inflamed eyelids and dry eye syndrome.  If you get flaky skin or crusting build up along your eyelid and lash roots, the pad version is your better option.  For a more gentle daily cleanser, the pump bottle version is much more economic because you can control the amount you need.  It is perfectly safe to use every day, and doubles as a gentle but effective eye makeup remover. Some people swear by diluted baby shampoo, but I often find it to be  too drying and irritating to the lid surface if needed for daily use.


When you are seen by your eye doctor, they will be checking the eyelash line and lids for signs of an inflammatory infection of Demodex.  Demodex is a parasitic mite that lives on our skin's hair follicles.  The amount of people with demodex infestations is jawdropping -- as high as 100% of people over age 70 are affected!  If your doctor sees a a Demodex infection, normal treatments may not be as effective for your inflamed, red eyelids.  Tea tree oil treatments are great at getting rid of Demodex; you can use a diluted tea tree oil shampoo to clean the eyelids nightly.

Demodex mites can be seen attached to the bash of your eyelashes during a regular eye examination. The only thing that really fights a demodex parasite is tea tree oil; other products (even steroid ointments)  are often of little success via

Oral Medications
During more acute flare-ups, oral medications may be needed to knock styes out of commission.  The go-to treatment for this purpose is oral doxycycline (or minocycline when there is a nation-wide shortage of doxy!)  For chronic use, a low dosage of doxycycline can be mild enough to keep styes at bay without causing side effects like upset stomach or sun burns.  A 50 mg dosage is generic, and can be enough to effectively decrease eyelid inflammation.  Dermatologists also frequently use the 20 mg dosage year round to fight acne and skin issues, and this low dosage works wonderfully on the eye as well for many patients. If you have rosacea or other skin issues with concurrent styes, oral doxycycline used more chronically (usually 1 month on, and 1 month off, or even all year round) can treat both issues at the same time.

Thinking of buying dietary supplements?  This is one time that you need to buy the name brand.  Fishy burps are not pleasant, but quite common in poorer concentrated fish oil products. via

Nutritional Supplements
Look for nutraceuticals with anti-inflammatory effects for best results.  Omega 3/fish oil is your best bet -- with 1500 mg a day being shown to effectively keep oil glands like the meibomian glands flowing with better gland secretion.  In the case of oral supplements, name brands can really be digested much better.  Nordic Naturals or Physician's Recommended get the best reviews.  Other options for improving tear gland function include flax seed oil and bilberry.

If you keep getting a stye in the same place?
See your doctor!  Recurrent styes are an unfortunately common problem if there is a skin chemistry issue, but the styes shouldn't keep coming back in the same place over and over.  This is more suspicious of a sebaceous gland carcinoma.  To rule out a cancerous lesion, your doctor is going to be looking for pigmentary changes, lash loss, defects to the shape of the eyelid margins.