From the Guidelines
The treatment for hordeolum, chalazion, and blepharitis primarily involves warm compresses and good eyelid hygiene, with the addition of topical or oral antibiotics in moderate to severe cases, as supported by the most recent evidence from 2024 studies 1.
Treatment Overview
The goal of treatment is to improve oil flow, reduce inflammation, and control bacterial overgrowth.
- Warm compresses applied for 10-15 minutes, 4-6 times daily, can help promote drainage and resolve hordeolum and chalazion.
- Daily eyelid hygiene using diluted baby shampoo or commercial eyelid cleanser is crucial for blepharitis.
- Topical antibiotics like erythromycin or azithromycin may be needed for moderate to severe blepharitis, and oral antibiotics like doxycycline (100mg twice daily for 2-4 weeks) may be prescribed in severe cases.
Specific Treatments
- For hordeolum, warm compresses and topical antibiotic ointments like erythromycin or bacitracin may be used.
- For chalazion, warm compresses and surgical incision and drainage by an ophthalmologist may be necessary if the condition persists beyond 4-6 weeks.
- For blepharitis, daily eyelid hygiene, warm compresses, and topical antibiotics like erythromycin or azithromycin may be used, with oral antibiotics like doxycycline prescribed in severe cases.
- Additional treatments like artificial tears, topical anti-inflammatory agents, and in-office procedural treatments like vectored thermal pulsation or microblepharoexfoliation may be considered in certain cases, as reported in recent studies 1.
Important Considerations
- The use of oral azithromycin may be associated with an increased risk of cardiovascular deaths, as reported in a Medicaid cohort study 1.
- The treatment of Demodex blepharitis may involve the use of topical tea tree oil or oral ivermectin, as well as in-office procedural treatments like microblepharoexfoliation, as discussed in recent studies 1.
- The optimal treatment regimen often requires persistence and a trial-and-error approach, with the patient's ability to perform daily eyelid hygiene and other treatments taken into consideration, as emphasized in the blepharitis preferred practice pattern 1.
From the Research
Treatment Options for Hordeolum, Chalazion, and Blepharitis
- Hordeolum and chalazion are the most frequent inflammatory eyelid tumors, which can occur in association with underlying diseases causing Meibomian gland dysfunction and/or chronic blepharitis 2.
- The majority of these lesions resolve spontaneously over time, but in some instances, surgical intervention is unavoidable 2.
- Treatment strategies for chalazia include hot compresses, intralesional steroid injections, and incision and curettage 3.
- For hordeolum, there is no evidence for or against the effectiveness of nonsurgical interventions, and controlled clinical trials would be useful in determining which interventions are effective for treatment 4, 5.
- Blepharokeratitis, a condition associated with blepharitis, can be treated with oral erythromycin in children, as an alternative to tetracycline, which is contraindicated in children under 8 years old 6.
Specific Treatment Approaches
- Hot compresses are a common treatment approach for hordeolum and chalazion 3, 2.
- Intralesional steroid injections can be used to treat chalazia 3.
- Incision and curettage is a surgical intervention used to treat chalazia 3, 2.
- Oral erythromycin can be used to treat blepharokeratitis in children 6.