What is the treatment for blepharitis?

Treatment for Blepharitis

The cornerstone of blepharitis treatment is daily eyelid hygiene with warm compresses and eyelid cleansing, which should be maintained long-term as the condition is typically chronic with no definitive cure. 1

First-Line Treatment: Eyelid Hygiene

Warm Compresses

• Apply warm compresses to eyelids for 10-15 minutes, 1-2 times daily 2, 1
• Purpose: Softens crusts/scales, warms meibomian secretions to improve flow
• Methods: Use hot tap water on clean washcloth, over-the-counter heat pack, or homemade bean/rice bag heated in microwave 2
• Caution: Avoid temperatures that could burn the skin 2

Eyelid Cleansing

• Follow warm compresses with gentle eyelid cleansing 2, 1
• For anterior blepharitis: Focus on removing crusts from eyelashes by rubbing side to side 2
• For posterior blepharitis/MGD: Perform vertical eyelid massage to express meibomian glands 2
• Cleansing options:
  • Diluted baby shampoo on pad, cotton ball, cotton swab, or clean fingertip 2
  • Commercial eyelid cleaners 2
  • Hypochlorous acid 0.01% cleansers (strong antimicrobial effect) 2

Second-Line Treatment: Topical Medications

For moderate to severe cases or when symptoms persist despite eyelid hygiene:

Topical Antibiotics

• Apply bacitracin or erythromycin ointment to eyelid margins 1-3 times daily for a few weeks 1, 3
• For blepharitis, all scales and crusts should be carefully removed before applying ointment uniformly over lid margins 3
• Rotate different antibiotics to prevent resistance development 1

Anti-inflammatory Agents

• For marked inflammation:
  • Short-term topical corticosteroids 2, 1
  • Longer-term management with topical cyclosporine 2, 1
  • Topical perfluorohexyloctane (FDA-approved in 2023) 2, 1

Third-Line Treatment: Systemic Medications

For severe, persistent posterior blepharitis/MGD not responding to topical treatments:

• Oral antibiotics: 2, 1
  • Doxycycline, minocycline, or tetracycline daily, tapered after clinical improvement
  • Erythromycin or azithromycin for children and pregnant women
  • Note: Tetracyclines have both antimicrobial and anti-inflammatory properties

Special Considerations

Patient Education

• Inform patients that blepharitis is typically chronic with no definitive cure 2, 1
• Eyelid hygiene must be continued long-term to control symptoms 2, 1

Precautions

• Patients with advanced glaucoma should avoid aggressive pressure during eyelid massage 2, 1
• Patients with neurotrophic corneas need careful counseling to avoid epithelial injury 2, 1
• Address moderate to severe blepharitis before intraocular surgery to reduce endophthalmitis risk 2, 1

Treatment Algorithm

1. Start with daily eyelid hygiene (warm compresses + cleansing)
2. If inadequate response after 2-4 weeks, add topical antibiotic ointment
3. For significant inflammation, add short-term topical corticosteroid
4. For persistent posterior blepharitis/MGD, consider oral antibiotics
5. For long-term management of chronic inflammation, consider topical cyclosporine or perfluorohexyloctane

The most recent evidence emphasizes that while treatment can significantly improve symptoms, patients must understand that blepharitis typically requires ongoing management rather than expecting complete resolution 2, 4.