From the Guidelines
Blepharitis and periorbital cellulitis require distinct management approaches due to their different pathophysiologies, with blepharitis typically treated with eyelid hygiene and topical antibiotics, and periorbital cellulitis requiring systemic antibiotics and potentially hospitalization. The differential diagnosis between blepharitis and periorbital cellulitis is crucial, as blepharitis presents with chronic eyelid margin inflammation, crusting, and irritation without significant periorbital swelling or systemic symptoms, while periorbital cellulitis manifests as acute-onset periorbital erythema, edema, warmth, and tenderness, often with fever 1.
Treatment Approaches
- Blepharitis treatment includes:
- Eyelid hygiene with warm compresses and gentle lid scrubs twice daily
- Artificial tears for associated dry eye
- Topical antibiotics such as erythromycin or bacitracin ointment applied to the lid margins at bedtime for 7-10 days in moderate to severe cases
- Short course of topical steroids for significant inflammation
- Periorbital cellulitis treatment includes:
- Systemic antibiotics such as amoxicillin-clavulanate for 7-10 days
- Alternatives like clindamycin or trimethoprim-sulfamethoxazole for penicillin-allergic patients
- Hospitalization for IV antibiotics in severe cases, especially in children or if orbital cellulitis is suspected
Key Considerations
- Distinguishing between blepharitis and periorbital cellulitis is crucial for appropriate management
- Blepharitis is managed outpatient, while periorbital cellulitis may require hospitalization
- Prompt ophthalmology consultation is necessary for periorbital cellulitis to rule out orbital involvement
- The most recent and highest quality study 1 supports the use of eyelid hygiene and topical antibiotics for blepharitis, and systemic antibiotics for periorbital cellulitis.
From the Research
Differential Diagnosis
- Blepharitis is a condition characterized by inflammation of the eyelid margin, which can be differentiated from periorbital cellulitis based on its symptoms and signs 2, 3.
- Periorbital cellulitis is an infection of the skin and tissues around the eye, which can be distinguished from blepharitis by its more severe symptoms, such as swelling, redness, and warmth of the affected area.
- A thorough medical history and physical examination are essential for differential diagnosis, as the symptoms of blepharitis and periorbital cellulitis can overlap 3, 4.
Treatment
- The mainstay of treatment for blepharitis is an eyelid hygiene regimen, which includes daily cleaning of the eyelids with a mild soap and warm water, and the use of topical antibiotics to reduce the bacterial load 3, 4.
- Topical corticosteroid preparations may be helpful in patients with marked inflammation, but their use should be limited to short periods due to potential side effects 3, 4.
- Oral antibiotics may be used in some cases of chronic blepharitis, but their effectiveness and safety are still uncertain, and more research is needed to determine their role in treatment 5.
- Treatment of periorbital cellulitis typically involves oral antibiotics, and in severe cases, hospitalization and intravenous antibiotics may be necessary.
Management
- Long-term management of blepharitis is crucial to prevent recurrence and reduce symptoms, and may include ongoing eyelid hygiene, topical antibiotics, and other therapeutic agents 2, 4.
- Patient education and self-management are essential for effective treatment of blepharitis, and patients should be instructed on proper eyelid hygiene and the use of therapeutic agents 3, 6.
- Regular follow-up with an eye care professional is necessary to monitor the condition and adjust treatment as needed.