From the Guidelines
For sore and dry eyelids, the most effective initial treatment is to apply warm compresses to closed eyes for 5-10 minutes twice daily, followed by gentle eyelid cleansing using a mild, diluted baby shampoo or commercial eyelid cleanser, as recommended by the 2024 blepharitis preferred practice pattern 1. This approach helps to loosen debris, stimulate oil glands, and reduce bacterial overgrowth, which are common underlying causes of eyelid discomfort.
- Warm compresses can be applied using a clean washcloth, over-the-counter heat pack, or homemade bean/rice bag heated in the microwave, taking care to avoid burns 1.
- Gentle eyelid cleansing can be performed using a mild, diluted baby shampoo or commercial eyelid cleanser, applied to a clean washcloth, cotton pad, or fingertip, and massaged along the lash line before rinsing thoroughly 1.
- Additional measures, such as artificial tears without preservatives (e.g., Systane, Refresh, or TheraTears) used 4-6 times daily, can help provide moisture and alleviate symptoms 1.
- For persistent symptoms, applying a thin layer of petroleum jelly or specialized eyelid ointment like Refresh PM to the eyelids before bedtime may be beneficial, while avoiding eye makeup during flare-ups and staying hydrated can also help 1. It is essential to note that if symptoms persist beyond 1-2 weeks or worsen, or if vision changes, severe pain, or discharge occur, consulting an eye care professional for prescription treatments may be necessary, as indicated by the 2024 blepharitis preferred practice pattern 1.
From the Research
Initial Treatment for Sore and Dry Eye Lids
The initial treatment for sore and dry eye lids can be approached in several ways, considering the various causes and symptoms of the condition.
- Artificial tears are often used as a first-line treatment to mimic tears and improve tear stability and properties 2.
- For Meibomian gland dysfunction (MGD), initial conservative therapy may include a combination of warm compresses and baby shampoo or eyelid wipes 3.
- In some cases, supplements rich in omega-3 fatty acids, tea tree oil, or topical antibiotics may be effective in treating MGD and dry eye symptoms 3.
- Topical N-acetylcysteine and topical cyclosporine can also be effective therapeutic adjuncts in patients with concurrent dry eye 3, 4.
Considerations for Treatment
When choosing a treatment, it's essential to consider the underlying causes of the condition, such as:
- Systemic diseases
- Meibomian gland dysfunction
- Anatomical abnormalities
- Neuropathic dysfunction 2
- The severity of the syndrome, which may dictate the need for substitution therapy, treatment of underlying eyelid diseases, or modification of environmental conditions 4
Over-the-Counter Artificial Tears
Over-the-counter (OTC) artificial tears can be an effective treatment for dry eye syndrome, but their efficacy can vary depending on the individual and the specific product used 5.
- A review of 43 randomized controlled trials found that 0.2% polyacrylic acid-based artificial tears were consistently more effective at treating dry eye symptoms than 1.4% polyvinyl alcohol-based artificial tears 5.
- However, the quality of evidence was assessed as low due to high risks of bias among included trials and poor reporting of outcome measures 5.