Keeping your eyes looking beautiful is more than using the best eye cream and having plastic surgery to remove the bags.  The simplest thing to do is take a look at your eyes in the mirror and see if they are red, puffy, or have lost their youthful glaze.  One of the most common and under diagnosed conditions in ophthalmology that causes the appearance of red, puffy eyelids is blepharitis.  To put it in perspective, blepharitis affects at least 30 million Americans.
    Frequently, when I tell a patient they have blepharitis they look at me and ask ‘how did I get that?’, and ‘am I contagious?’, ‘how can I get rid of it?’
    Blepharitis is essentially inflammation seen along the base of the eyelashes.  Blepharitis can be subdivided into inflammation seen on the anterior lid margin and posterior lid margin.  The difference is diagnosed by your ophthalmologist but the symptoms and treatment are different.  For example, if you complain of crusts on the lids upon awakening, eyelid redness, itching, loss of lashes and puffiness you may suffer from anterior blepharitis.  Anterior blepharitis is usually caused from either bacteria along the lid margin or seborrheic dermatitis.  The most common type of bacteria in anterior blepharitis is staphylococcus aureus and Staphylococcus epidermidis.  This type of blepharitis responds well to antibiotics, warm compresses and keeping the eyelid margin clean.  Seborrheic blepharitis can also cause itching, redness and puffiness, but the treatment is a little more complicated and needs the attention of your ophthalmologist and dermatologist.
    Posterior blepharitis is inflammation and abnormality of the meibomian glands.   These are tiny glands just posterior to your eyelashes that are important in regulating the amount of lipids in the normal tear fluid.  Posterior blepharitis is almost always not infectious and difficult to cure because its cause is usually related to an abnormality in function and quality of lipids in the tear film. 
    The lipids in the tear film are important in helping your tears stick to the surface of your eye.  If you complain of burning red eyes, filmy vision, contact lens intolerance, recurrent chalazia (sty), gritty sensation, and foamy tear film you may suffer from posterior blepharitis.  Posterior blepharitis is usually associated with rosacea (skin disease characterized by an abnormality in the sebaceous glands of the face and chest), dermatologic diseases, and dry eye disease. 
    The management of posterior blepharitis involves warm compresses to melt the oils in the meibomian glands; lid hygiene to open the meibomian gland orifices; treatment of conconmittment dry eye disease, and establishing healthier meibomian gland secretions with either antibiotics and/or increasing consumption of omega-3 fatty acids.
    Beware that if you have symptoms only involving one eye to seek medical attention. What appears like blepharitis may be sebaceous cell cancer of the lid.  Sebaceous cell cancer looks like blepharitis but is a deadly cancer that can spread to other body organs.  It can only be diagnosed by a biopsy of the lid margin.
    So before you jump off to your plastic surgeon or buy the latest and greatest eye cream, make a visit to your ophthalmologist to make sure there is not a medical condition causing your eyes to look the way they do.