What is the treatment for blepharitis?

From the Guidelines

Treatment for Blepharitis

The most effective treatment for blepharitis involves a combination of good eyelid hygiene, including warm compresses and gentle scrubbing of the eyelids with a mild soap or baby shampoo 1.

• Warm compresses can be applied to the eyelids for several minutes to soften adherent scurf and scales or discharge and/or warm the meibomian secretions.
• Eyelid cleansing can be accomplished by brief, gentle massage of the eyelids, and eye cleaners with hypochlorous acid at 0.01% have a strong antimicrobial effect.
• Artificial tears can be used to help soothe and moisturize the eyes, with preservative-free options preferred for long-term use.
• Antibiotic ointments such as erythromycin or bacitracin can be applied to the eyelids 2-3 times a day for 2-4 weeks to reduce bacterial load.
• In cases of more severe inflammation, a short course of oral antibiotics such as doxycycline 50-100 mg twice daily for 2-4 weeks may be necessary 2.
• For patients with meibomian gland dysfunction, omega-3 fatty acid supplements 1000 mg daily may be beneficial.
• Corticosteroid eye drops or ointments may be used for short-term control of inflammation, but their use should be limited due to potential side effects.
• Topical perfluorohexyloctane was FDA approved in 2023 and is a prescription treatment that prevents tear evaporation and was shown to improve symptoms and corneal staining in patients with dry eye disease after 8 weeks of treatment 2.
• Demodex blepharitis can be treated with tea tree oil shampoo or eyelid scrubs, and topical lotilaner was recently FDA approved for the treatment of Demodex blepharitis 3.

It is essential to note that treatment should be tailored to the individual patient and may need to be adjusted based on response and severity of symptoms. Regular follow-up with an eye care professional is recommended to monitor treatment effectiveness and adjust the treatment plan as needed. In-office procedural treatments such as vectored thermal pulsation therapy and microblepharoexfoliation may also be beneficial for some patients 3.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: The ointment should be applied directly into the conjunctival sac 1 to 3 times daily. In blepharitis all scales and crusts should be carefully removed and the ointment then spread uniformly over the lid margins. The treatment for blepharitis involves:

• Removing all scales and crusts from the lid margins
• Applying bacitracin ointment uniformly over the lid margins
• Applying the ointment 1 to 3 times daily 4

From the Research

Treatment Options for Blepharitis

The treatment for blepharitis varies depending on the cause, location, and severity of the disease. Some of the treatment options include:

• Eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers 5, 6, 7, 8
• Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid 5, 6, 7
• Heat therapy/thermal pulsation treatment to clear obstruction in the meibomian glands and restore meibum secretions 5
• Topical corticosteroid preparations to reduce inflammation 6, 7
• Systemic antibiotics in some cases 6, 7
• Systemic intake of omega-3 fatty acids for its anti-inflammatory potential 7
• Lubricants to help with dry eye symptoms 7

Treatment for Specific Types of Blepharitis

For anterior blepharitis, treatment options include:

• Eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers 5
• Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid 5 For posterior blepharitis/meibomian gland dysfunction (MGD), treatment options include:
• At-home warm compress or in-office administration of heat therapy/thermal pulsation treatment 5

General Recommendations

• Scrupulous eye hygiene along with good handwashing habits can help keep most cases of blepharitis under control 8
• Contact lens wearers must be careful of cross-contamination between eye, lens, lens solutions, or lens cases, and cosmetics should be used properly and with care 8
• A combination of remedial measures that addresses eyelids hygiene and includes medicated and device therapy can be an effective method of treating chronic blepharitis 9