management

Last edited 05/2022 and last reviewed 03/2023

Blepharitis is typically a chronic condition that cannot be permanently cured but long-term management of symptoms can address both infectious and inflammatory components of the disease (1,2).

Non pharmacological management:

  • lid hygiene is the first line of treatment regardless of type of blepharitis (3) – due to the chronic nature of the condition patients should continue eye lid hygiene even after improvement
    • apply warm compress on eyelids for 5–10 minute intervals
      • helps in expression of meibomian gland secretions and to loosen collarettes and crusts
    • use of eyelid scrubs (diluted baby shampoo, sodium bicarbonate solution or dedicated lid cleaning solution with a swab or cotton bud):
      • to wipe away bacteria and deposits from lid margins and mechanically expresses the lid glands
      • done twice daily at first, then reduce to once daily as condition improves
      • firm pressure should be applied with swab or cotton bud so as to express glands
    • eyelid massage – pressing the eyelid against the eyeball will aid in expressing Meibomian glands, more useful in posterior lid disease or MGD (1,4)
  • avoidance of cosmetics – especially eye liner and mascara
  • seborrhoeic dermatitis and dandruff  should be treated (4)
  • mechanical irritation due to over vigorous scrubbing or sensitivity reaction to detergents may be a few adverse effects of this management method (1)

Pharmacological management:

  • antibiotics - should be considered when an infection is present and after lid hygiene manoeuvres.:
    • topical antibiotic e.g. fusidic acid eye drops, applied twice daily after lid hygiene (the lid margins are cleaned once or twice a day with a cotton bud moistened with lukewarm, previously boiled, water) (1)
      • some may require long-term therapy to remain symptom free (1)
        • if chronic blepharitis, then long-term treatment will generally be required
          • if chronic blepharitis then consult expert advice
          • may require oral tetracycline +/- topical antibiotics
    • oral tetracycline e.g. oxytetracycline, doxycycline or minocycline
      • used when lid hygiene and topical antibiotic fails
      • in patients with MGD or rosacea
      • used for several weeks and tapered after clinical improvement is noted
      • contraindicated in pregnant or lactating women or children younger than 12 years – use oral erythromycin or azithromycin (4)
    • topical azithromycin (5) has been used
      • proposed as novel treatment for posterior blepharitis due to its antibacterial and anti-inflammatory properties
    • anti-Demodex therapy – should be managed by ophthalmologists and experienced practitioners (3)
  • low-dose topical corticosteroids
    • seek expert advice
      • a short course during an acute exacerbation (typically a drop several times a day) tapered to discontinuation over one to three weeks can sometimes be prescribed (1).

Reference:

Related pages:

Demodex mites and blepharitis