From the Guidelines
Management of eczematous blepharitis involves a combination of eyelid hygiene, topical medications, and addressing underlying conditions, with the most recent and highest quality study 1 recommending warm compresses and eyelid cleansing as the initial step in treatment. The patient must understand that a cure is usually not possible, but continual daily treatment can significantly improve symptoms. Some key points to consider in the management of eczematous blepharitis include:
- Warm compresses applied to closed eyelids for 5-10 minutes twice daily to loosen debris and improve meibomian gland function
- Gentle lid cleansing using diluted baby shampoo or commercial eyelid cleansers
- Topical perfluorohexyloctane, which was FDA approved in 2023 and has been shown to improve symptoms and corneal staining in patients with dry eye disease 1
- Topical antibiotics, such as bacitracin or erythromycin, which can be prescribed and applied on the eyelid margins one or more times daily or at bedtime for a few weeks
- Oral tetracyclines, such as doxycycline, which can be given daily and tapered after clinical improvement is noted, but should be used with caution due to potential side effects and contraindications 1 It is essential to tailor the therapeutic plan to the patient's ability to perform the treatment and to consider the potential risks and benefits of each treatment option. Regular follow-up appointments are necessary to monitor the patient's response to treatment and adjust the treatment plan as needed. In severe or refractory cases, referral to a dermatologist for systemic therapy consideration may be necessary. Overall, the goal of treatment is to improve symptoms, reduce inflammation, and prevent long-term complications, with a focus on minimizing morbidity, mortality, and improving quality of life.
From the Research
Management of Eczematous Blepharitis
- The management of eczematous blepharitis involves a combination of eyelid hygiene, topical antibiotics, and topical corticosteroids 2.
- Topical calcineurin inhibitors, such as cyclosporin A and pimecrolimus, may also be useful in treating chronic blepharokeratoconjunctivitis, including eczematous blepharitis, in addition to lid hygiene and lubricants 3.
- Oral antibiotics, such as doxycycline, may be used to treat chronic blepharitis, but the evidence for their effectiveness is very uncertain, and they may cause more adverse events 4.
Treatment Options
- Tacrolimus ointment has been shown to be effective in treating refractory posterior blepharitis, including eczematous blepharitis, with improvements in symptoms and ocular surface status 5.
- The medical management of blepharitis, including eczematous blepharitis, has expanded to include topical and oral antibiotics, steroids, and calcineurin inhibitors, in addition to eyelid hygiene 6.
- Dietary considerations and interventional procedures may also play a role in the future of blepharitis management, including eczematous blepharitis 6.
Key Considerations
- The pathophysiology of blepharitis, including eczematous blepharitis, is complex and involves abnormal lid-margin secretions, microbial organisms, and abnormalities of the tear film 2.
- Blepharitis, including eczematous blepharitis, can present with a range of signs and symptoms, and its management can be complicated by a number of factors, including associated dermatological conditions such as seborrheic dermatitis, rosacea, and eczema 2.