From the Guidelines
Blepharitis treatment involves a combination of eyelid hygiene and medications, starting with warm compresses and gentle eyelid scrubbing, and may include topical antibiotics, corticosteroids, and oral medications like doxycycline for cases with rosacea involvement, as recommended by the most recent guidelines 1. The treatment approach should be tailored to the individual patient's needs, taking into account the severity of symptoms, the presence of rosacea or other underlying conditions, and the patient's ability to perform eyelid hygiene and other treatments.
- Warm compresses should be applied to closed eyelids for 5-10 minutes twice daily to loosen crusts and oil buildup.
- Gentle eyelid scrubbing can be performed using diluted baby shampoo or commercial eyelid cleansers like OCuSOFT or SteriLid on a clean washcloth or cotton swab.
- Topical antibiotics such as erythromycin or bacitracin ointment can be applied to the eyelid margins at bedtime for 1-2 weeks for moderate to severe cases.
- A short course of topical corticosteroids like fluorometholone 0.1% drops may be prescribed if there's significant inflammation.
- Oral doxycycline 100mg once or twice daily for 2-4 weeks can help for cases with rosacea involvement, as supported by recent studies 1.
- Artificial tears can provide relief from associated dry eye symptoms.
- Omega-3 fatty acid supplements (1000-2000mg daily) may reduce inflammation over time, although the evidence is not yet conclusive 1. It is essential to note that blepharitis is typically chronic, and maintaining regular eyelid hygiene is crucial for long-term management. The condition stems from bacterial overgrowth and dysfunction of the meibomian glands that produce oils for the tear film, which is why addressing both the bacterial component and improving oil gland function is essential for effective treatment, as highlighted in the latest guidelines 1.
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. For blepharitis treatment, the recommended approach is to:
- Remove all scales and crusts from the lid margins
- Apply bacitracin ointment uniformly over the lid margins
- Use the ointment 1 to 3 times daily 2
From the Research
Blepharitis Treatment Options
- Demodex blepharitis is a common disease of the eyelid, affecting approximately 25 million Americans 3
- The disease is characterized by direct mechanical damage, hypersensitivity, and inflammation caused by Demodex mites 3
- Risk factors for Demodex blepharitis include increasing age, rosacea, and diabetes 3
Current Management Options
- Several oral, topical, eyelid hygiene, and device-based options have been used clinically and evaluated in studies for the management of Demodex blepharitis 3
- However, none of these options have been FDA approved to treat the disease 3
- Topical ivermectin 1% cream application has been shown to improve symptoms, ocular surface staining, eyelid debris, redness/swelling, and telangiectasia in patients with Demodex blepharitis 4
- Oral antibiotics, such as doxycycline, may improve clinical signs, but the evidence is very uncertain and may cause more adverse events 5
Emerging Therapies
- Lotilaner ophthalmic solution, 0.25%, has been shown to eradicate Demodex mites and eliminate collarettes and eyelid redness for an extended period 3
- Topical ivermectin-metronidazole gel therapy has been found to be effective in the treatment of blepharitis caused by Demodex spp. 6
- Tea tree oil (TTO) 5%, a cleansing foam containing 0.02% TTO, and metronidazole 2% ointment have been used as additional topical treatment options, but their efficacy is unclear 7