From the Guidelines
Blepharitis treatment involves a consistent eyelid hygiene routine as the primary approach, with warm compresses and gentle lid scrubbing being the most effective methods, as recommended by the most recent study 1. The treatment of blepharitis typically involves a combination of eyelid hygiene, warm compresses, and topical or oral medications.
- Warm compresses should be applied to the eyelids for 5-10 minutes twice daily to loosen debris and oil.
- Gentle lid scrubbing with diluted baby shampoo or commercial eyelid cleanser on a clean washcloth or cotton swab should be performed to remove crusting and debris from the eyelashes.
- For moderate cases, topical antibiotics like erythromycin or bacitracin ointment may be applied to the lid margins at bedtime for 1-2 weeks, as supported by studies 1.
- Severe or persistent cases might require oral antibiotics such as doxycycline 100mg once or twice daily for 2-4 weeks, which helps reduce inflammation and alter oil composition, as recommended by recent studies 1.
- Topical corticosteroids like fluorometholone 0.1% drops may be prescribed short-term (1-2 weeks) for significant inflammation, but their use should be limited due to potential side effects, as noted in the literature 1.
- For associated dry eye, artificial tears can provide relief, especially those containing oil or lipid-based products, as suggested by recent research 1. Blepharitis is typically chronic, requiring ongoing maintenance therapy even after symptoms improve, and the condition often stems from bacterial overgrowth, meibomian gland dysfunction, or skin conditions like seborrheic dermatitis, which is why consistent eyelid hygiene is crucial for managing the underlying causes and preventing recurrence, as emphasized by the most recent study 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: The ointment should be applied directly into the conjunctival sac 1 to 3 times daily. In blepharitis all scales and crusts should be carefully removed and the ointment then spread uniformly over the lid margins. The treatment for blepharitis involves:
- Removing all scales and crusts from the lid margins
- Applying bacitracin ointment uniformly over the lid margins
- Applying the ointment 1 to 3 times daily directly into the conjunctival sac 2
From the Research
Treatment Options for Blepharitis
The treatment for blepharitis varies depending on the cause, location, and severity of the disease. Some of the treatment modalities include:
- Eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers for anterior blepharitis 3
- Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid to accompany eyelid hygiene 3, 4, 5
- At-home warm compress or in-office administration of heat therapy/thermal pulsation treatment to clear obstruction in the meibomian glands and restore meibum secretions for posterior blepharitis/meibomian gland dysfunction (MGD) 3
- Oral erythromycin treatment for childhood blepharokeratitis, as an alternative to tetracycline which is contraindicated in children aged less than 8 years 6
- Fixed combinations of a topical antibiotic and a corticosteroid for effective and convenient treatment of both infectious and inflammatory components of the disease 4
- Systemic antibiotics may be appropriate in some patients 5
Eyelid Hygiene Regimens
Different eyelid hygiene regimens have been compared in studies, including:
- Commercial lid scrubs
- Dilute baby shampoo
- Hypo-allergenic bar soap
- Studies have shown that patients prefer commercial lid scrubs for convenience and ease of use, and that all three regimens can improve slit lamp findings 7
Management of Blepharitis
The mainstay of treatment for blepharitis is an eyelid hygiene regimen, which needs to be continued long term 5. Topical antibiotics are used to reduce the bacterial load, and topical corticosteroid preparations may be helpful in patients with marked inflammation 4, 5.