From the Guidelines
The treatment for suspected blepharitis or eyelid eczema typically involves gentle eyelid hygiene and targeted medications, with warm compresses and eyelid cleansing being the first line of treatment, as recommended by the most recent guidelines 1. For daily eyelid hygiene, apply a warm compress to the closed eyelids for 5-10 minutes, then gently clean the eyelid margins with diluted baby shampoo or commercial eyelid cleansers using a clean washcloth or cotton swab.
- Warm compresses can be achieved by using hot tap water on a clean washcloth, over-the-counter heat pack, or homemade bean/rice bag that can be heated in the microwave, as described in the blepharitis preferred practice pattern 1.
- Eyelid cleansing can be accomplished by brief, gentle massage of the eyelids, and eye cleaners with hypochlorous acid at 0.01% have a strong antimicrobial effect, which has been used for the treatment of both anterior and posterior blepharitis 1. For blepharitis, topical antibiotics like erythromycin or bacitracin ointment can be applied to the eyelid margins at bedtime for 1-2 weeks, and severe cases may require oral antibiotics such as doxycycline 100mg twice daily for 2-4 weeks, although the use of oral azithromycin may be an alternative, as shown in a study 1. For eyelid eczema, a mild topical corticosteroid like hydrocortisone 1% cream can be carefully applied to the affected areas twice daily for 5-7 days, avoiding contact with the eye itself, and for persistent eczema, tacrolimus 0.03% or pimecrolimus 1% ointment may be used as steroid-sparing alternatives, as recommended by the guidelines 1. These treatments work by reducing bacterial load on the eyelids and controlling inflammation, and if symptoms don't improve within two weeks, or if vision changes, pain, or worsening redness develops, seek professional medical evaluation as more specialized treatment may be needed, as emphasized in the clinical objectives of the blepharitis preferred practice pattern 1.
From the FDA Drug Label
Text: Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema Text: Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily
The treatment for suspected blepharitis or eczema on the eyelids is to apply hydrocortisone to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older. For children under 2 years of age, it is recommended to ask a doctor. Hydrocortisone is used to temporarily relieve itching associated with minor skin irritations, inflammation, and rashes due to eczema 2 2.
From the Research
Treatment for Suspected Blepharitis or Eczema on the Eyelids
The treatment for suspected blepharitis or eczema on the eyelids involves a combination of eyelid hygiene, topical antibiotics, and topical corticosteroids.
- Eyelid hygiene is the mainstay of treatment, which includes cleaning the eyelids with a mild soap or a commercial lid scrub 3.
- Topical antibiotics may be used to reduce the bacterial load, and topical corticosteroid preparations may be helpful in patients with marked inflammation 3.
- A comparative study found that a phospholipid-liposome solution was more effective than baby shampoo in improving symptoms of dry eye in contact lens wearers with blepharitis 4.
- Another study found that a commercial lid scrub was preferred by patients over soap or dilute baby shampoo for eyelid hygiene 5.
- A steroid-antibiotic combination was found to be more effective than steroid alone in reducing bacterial counts and alleviating symptoms in patients with chronic bacterial blepharitis or conjunctivitis 6.
- However, a systematic review found that there is not enough evidence to support the routine recommendation of eyelid wipes, and long-term costs and potential adverse effects should not be overlooked 7.
Eyelid Hygiene Regimens
Different eyelid hygiene regimens have been studied, including:
- Baby shampoo 4, 5
- Commercial lid scrubs 4, 5
- Phospholipid-liposome solutions 4
- Tea tree oil-based products 7
- Common household products 7
Topical Treatments
Topical treatments that may be used in the management of blepharitis or eczema on the eyelids include: