From the Guidelines
For blepharitis, erythromycin ophthalmic ointment is typically the first-line antibiotic treatment. This is based on the most recent and highest quality study available, which recommends the use of topical antibiotics such as bacitracin or erythromycin for symptomatic relief and to decrease bacteria from the eyelid margin in cases of anterior blepharitis 1.
Key Points to Consider
- Apply a small amount (about 1 cm) to the eyelid margins one or more times daily or at bedtime for a few weeks, as guided by the severity of the blepharitis and response to treatment 1.
- Bacitracin or azithromycin ointments are good alternatives if erythromycin isn't available or tolerated.
- Antibiotic treatment should be combined with daily eyelid hygiene, including warm compresses and gentle lid scrubs to remove debris and reduce bacterial load.
- These measures help address the underlying inflammation and bacterial overgrowth that characterize blepharitis.
- For severe or recurrent cases, oral antibiotics like doxycycline might be necessary, especially for patients with meibomian gland dysfunction (MGD) whose chronic symptoms and signs are not adequately controlled by eyelid cleansing or meibomian gland expression 1.
- Remember that blepharitis is often chronic, so maintaining good eyelid hygiene even after symptoms improve is essential for preventing recurrence.
Additional Considerations
- The frequency and duration of treatment should be guided by the severity of the blepharitis and response to treatment, and topical antibiotic treatment can be repeated on an intermittent basis using different kinds of medications with different mechanisms of action to prevent the development of resistant organisms 1.
From the FDA Drug Label
In blepharitis all scales and crusts should be carefully removed and the ointment then spread uniformly over the lid margins. The best antibiotic ointment for blepharitis is bacitracin (OPHTH), as it is directly mentioned in the drug label for use in blepharitis treatment 2.
- Key points:
- Apply ointment directly into the conjunctival sac 1 to 3 times daily
- Remove all scales and crusts before applying the ointment
- Spread the ointment uniformly over the lid margins The other option, erythromycin (OPHTH), does not have direct information in the label regarding its use for blepharitis 3.
From the Research
Antibiotic Ointments for Blepharitis
- The most effective antibiotic ointment for blepharitis is not explicitly stated in the provided studies, but some studies suggest that azithromycin ophthalmic solution may be more effective than erythromycin ophthalmic ointment 4.
- Topical antibiotics, such as azithromycin, can be used to reduce the bacterial load in blepharitis patients 5, 6.
- Fixed combinations of a topical antibiotic and a corticosteroid may offer an effective and convenient treatment modality for blepharitis, addressing both infectious and inflammatory components of the disease 6.
Treatment Options
- Eyelid hygiene remains the foundation of most treatment regimens for blepharitis 5, 6, 7.
- Topical corticosteroid preparations may be helpful in patients with marked inflammation 5.
- Oral antibiotics, such as doxycycline, may be used to treat chronic blepharitis, but the evidence for their effectiveness is very uncertain 8.
- Other treatment options, such as dietary considerations and interventional procedures, may also play a role in the management of blepharitis 7.
Study Findings
- A study comparing azithromycin ophthalmic solution to erythromycin ophthalmic ointment found that azithromycin was more effective in treating chronic mixed anterior blepharitis 4.
- A review of recent clinical trials found that antibiotics and topical corticosteroids can produce significant improvement in signs and symptoms of blepharitis 6.
- A study on the use of oral antibiotics for chronic blepharitis found that the evidence for their effectiveness is very uncertain, and that they may cause more adverse events 8.