Crusty lashes, irritated eyelids and gritty eyes can be signs of blepharitis or meibomian gland dysfunction (MGD). Blepharitis is inflammation around the eyelid margins. MGD affects the glands that supply oil to your tears. They often occur together, but the treatment depends on what is causing your symptoms.
At Vision Camberwell Optometrists, we assess your eyelids, gland secretions and eye surface, then explain a practical care plan. This may include home eyelid care, treatment for associated dry eye and, for selected patients, ZEST eyelid cleaning.
Contents
What is the difference between blepharitis and MGD?
Blepharitis affects the eyelid edges. Anterior blepharitis involves the lash line, where crusts and debris may collect. Bacteria, skin conditions and Demodex mites can contribute. Posterior blepharitis affects the inner lid margin and is often associated with MGD. An examination helps identify which features are present. 1
Meibomian glands sit within the upper and lower eyelids. Their oily secretion helps the tear film remain stable and limits evaporation. MGD can involve blocked gland openings or changes in the amount or quality of that oil. It can contribute to evaporative dry eye, although dry eye often has several causes. MGD and posterior blepharitis overlap, but they are not interchangeable terms: gland dysfunction can occur without obvious eyelid inflammation. 2
What symptoms should I look for?
You may notice flakes around the lashes, sticky lids on waking, burning, grittiness, watering or redness. Vision can fluctuate when the tear film is unstable. These symptoms do not establish a diagnosis by themselves, and allergy or other eye-surface conditions may feel similar. 1
Tell us when symptoms occur, whether one or both eyes are affected, and what you have already tried. Bring the names of your eye drops, eyelid products and medicines so we can review your current routine.
How we assess your eyelids
We examine the lash line, eyelid margins and eye surface under magnification. We may gently press selected glands to assess how readily oil is released and what it looks like. Tear-film stability, surface staining and blinking can help show how the eyelids and tears are working together. The findings guide your plan rather than symptoms alone. 3
What does meibography show?
Meibography is imaging that shows the shape and visibility of the meibomian glands. It can identify areas of apparent gland loss, but it does not directly measure how well each gland works. Images need to be interpreted alongside gland expression, symptoms and the rest of the examination. VCO does not perform meibography; we can refer you if it is indicated. 3
Treatment matched to your findings
There is no single treatment that suits every case. Current TFOS DEWS III guidance supports matching care to the factors identified during assessment. Someone with lash-line debris may need a different approach from someone with poor oil flow, significant inflammation or several dry-eye contributors. 4
Warm compresses and gentle eyelid care
When appropriate, a comfortably warm compress can help soften thickened gland secretions. Gentle eyelid cleaning can remove accumulated debris. We will demonstrate the technique and recommend the frequency and duration for your situation. Follow the instructions for any heat mask, avoid excessive heat, and do not forcefully squeeze your eyelids. 4
A routine should be manageable enough to follow consistently. At review, tell us if cleaning stings, the compress feels too hot or the routine is difficult to maintain so we can adjust the plan.
Drops and prescribed treatment
Lubricating drops may help an unstable tear film, but they do not address every eyelid problem. Some patients need prescribed treatment for inflammation or a particular contributing condition. We will explain the purpose, likely benefits, precautions and review requirements of any recommended medicine. 4
Demodex-related blepharitis needs its own assessment and treatment advice. Do not assume that all lash debris is caused by mites or use concentrated essential oils around your eyes.
ZEST eyelid cleaning at VCO
We offer ZEST, the Zocular Eyelid System Treatment, for selected patients with eyelid-margin buildup. This in-practice procedure uses a formulated cleanser around the lash line and eyelid margins to help remove accumulated material. The cleaning usually takes around 10–15 minutes; your overall appointment may be longer.
The published evidence is limited. A retrospective study of 19 patients reported improvements in some dry-eye signs and symptoms after gel-based lid cleaning. Its small size and lack of a control group mean it cannot establish superiority over other treatments or predict your individual result. 5
ZEST is an option within a broader care plan. It is not a permanent cure, a way to regrow lost glands or a replacement for all home care. We will discuss why it may be appropriate before recommending it.
Other in-practice treatments and referral
Depending on the findings, we may recommend in-practice gland expression or heated eyelid treatment with Blephasteam. IPL is not offered at VCO; we can refer you if it is indicated.
A systematic review found that IPL probably improves MGD-related dry-eye symptoms compared with placebo. Its additional benefit alongside standard care was less certain, as was the evidence about adverse events. Suitability, cost, precautions and the need for repeat treatment should be discussed individually. 6
Follow-up and longer-term care
Blepharitis commonly recurs, so improvement may still require maintenance and review. A flare does not automatically mean your treatment has failed. We will agree on when to reassess and whether your routine needs changing. 1
At follow-up, we can compare your symptoms, eyelid findings and response to treatment. If irritation persists, the next step is to reassess the contributing factors rather than simply repeat the same procedure.
Selected people with severe, persistent ocular-surface disease may benefit from scleral lenses as part of a broader plan. These lenses protect the eye surface beneath a fluid reservoir. They do not reopen blocked meibomian glands or restore lost gland tissue, and are not a routine next step for uncomplicated MGD. 4
When to seek urgent assessment
Significant eye pain, marked light sensitivity or a sudden change in vision needs urgent assessment. Do not assume these symptoms are a routine blepharitis flare or wait for a scheduled review. Contact an eye-care provider promptly; if urgent care is unavailable, attend an emergency department.
Frequently asked questions
Can blepharitis and MGD cause dry eye?
Yes. Eyelid inflammation and altered gland secretions can destabilise the tear film. However, they may be only part of the problem, which is why an assessment also considers the eye surface and other tear-film factors. 2
Why do my eyes water if the problem is dry eye?
An irritated eye surface can trigger watering even when the tear film is unstable. Watering has other possible causes too, so persistent symptoms deserve an examination rather than assuming you need a particular drop.
Will eye drops alone clear blocked glands?
Drops may improve comfort, but blocked or poorly functioning glands can also require eyelid-directed care. Your optometrist can explain whether warmth, cleaning or another approach is appropriate. 4
Can blepharitis be cured permanently?
It often needs ongoing management rather than a one-off cure. The aim is to improve comfort, control eyelid inflammation and establish a routine that keeps symptoms manageable. 1
How often should I clean my eyelids?
Follow the routine recommended after your assessment. The right product, technique and frequency depend on your eyelids and how they respond. More vigorous cleaning is not necessarily better.
Is ZEST suitable for everyone with dry eye?
No. It targets eyelid-margin buildup and will not address every cause of dry eye. We recommend it selectively and explain the limited evidence, alternatives and expected role in your care.
Do I need a scan of my meibomian glands?
Not everyone does. Imaging can add information about gland structure, but it complements rather than replaces an examination of secretion quality, oil flow and the eye surface. 3
Can I book an eyelid assessment in Camberwell?
Yes. Contact Vision Camberwell Optometrists and describe your symptoms so we can arrange an appropriate eye test or dry-eye assessment. Let us know if you would like an appointment with Jue Wang in Mandarin.
Book an eyelid and dry-eye assessment
If crusty lashes, sticky lids or ongoing grittiness are bothering you, we can assess the cause and explain your options.
Visit Vision Camberwell Optometrists at 784 Burke Road, Camberwell VIC 3124, or call (03) 9882 5666. Consultations are available in English, with Mandarin available with Jue Wang.
References
- Lin A, Ahmad S, Amescua G, et al. Blepharitis Preferred Practice Pattern. Ophthalmology. 2024;131(4):P50–P86.
- Nelson JD, Shimazaki J, Benitez-del-Castillo JM, et al. The International Workshop on Meibomian Gland Dysfunction: Report of the Definition and Classification Subcommittee. Investigative Ophthalmology & Visual Science. 2011;52(4):1930–1937.
- Wolffsohn JS, Benítez-Del-Castillo J, Loya-Garcia D, et al. TFOS DEWS III: Diagnostic Methodology. American Journal of Ophthalmology. 2025;279:387–450.
- Jones L, Craig JP, Markoulli M, et al. TFOS DEWS III: Management and Therapy. American Journal of Ophthalmology. 2025;279:289–386.
- Diaz-Vega B, Rodriguez-Fabuel C, Vitores-Mate S, Carpena-Torres C. Lid scrubbing with a gel combining natural extracts for dry eye treatment. International Journal of Ophthalmology. 2023;16(7):1053–1059.
- Peira N, Ali EM, Modén NK, et al. Effectiveness and safety of intense pulsed light therapy for dry eye symptoms due to meibomian gland dysfunction: A systematic review and meta-analysis. Acta Ophthalmologica. 2025;103(4):371–379.
Reviewed by Dr Shonit Jagmohan, Optometrist. Last reviewed October 2026.
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