What is the treatment for blepharitis?

Treatment for Blepharitis

The foundation of blepharitis treatment is daily eyelid hygiene with warm compresses and gentle cleansing, combined with targeted therapies based on the type and severity of blepharitis. 1 This approach forms the cornerstone of management for this chronic inflammatory condition of the eyelid margins.

First-Line Treatment

Eyelid Hygiene

• Warm compresses: Apply for 10-15 minutes, 3-4 times daily
  • Use hot tap water on a clean washcloth, over-the-counter heat pack, or homemade bean/rice bag heated in the microwave
  • Particularly helpful for posterior blepharitis/meibomian gland dysfunction (MGD) 1

Eyelid Cleansing

• Gently rub the base of eyelashes using:
  • Diluted baby shampoo
  • Commercially available eyelid cleaner
  • Hypochlorous acid 0.01% cleaners
• Use a pad, cotton ball, cotton swab, or clean fingertip 1
• For anterior blepharitis: Focus on removing crusting from eyelashes
• For posterior blepharitis: Include vertical eyelid massage to express meibomian gland secretions 1

Second-Line Treatment

Topical Antibiotics

• Bacitracin or erythromycin ointment applied to eyelid margins once or more daily for 5-7 days 1
• For bacitracin: Apply directly into the conjunctival sac 1-3 times daily; for blepharitis, carefully remove all scales and crusts and spread uniformly over lid margins 2

Anti-inflammatory Therapy

• Short-term use of topical corticosteroids for marked inflammation 1
• Cyclosporine may be beneficial in some cases 1

Third-Line Treatment

Oral Antibiotics

For persistent posterior blepharitis/MGD:

• Doxycycline, minocycline, or tetracycline with daily dose tapered after improvement 1
• Specific dosing recommendations:
  • Dicloxacillin: 500 mg four times daily for adults
  • Cephalexin: 500 mg four times daily for adults or 25-50 mg/kg/day in 4 divided doses for children
  • Clindamycin: 300-450 mg three times daily for adults or 10-20 mg/kg/day in 3 divided doses for children 1

Important Cautions

• Tetracyclines are contraindicated in pregnancy, nursing women, and children under 8 years
• Can cause photosensitization, gastrointestinal upset, and rarely, azotemia 1
• Oral azithromycin may lead to serious heart rhythm irregularities 1

Fourth-Line Treatment

• Vectored thermal pulsation and microblepharoexfoliation procedures 1
• For persistent chalazia: Intralesional steroid injection or incision and curettage 1

Treatment Duration and Follow-up

• Blepharitis is typically a chronic condition requiring long-term management
• Initial treatment should be reassessed after 2-4 weeks 1
• Cleansing treatment often required long-term as symptoms recur when treatment is discontinued 1

Special Considerations

Prevention of Recurrence

• Continue regular eyelid hygiene
• Remove eye makeup completely
• Treat underlying conditions (e.g., rosacea, seborrheic dermatitis) 1, 3
• Discontinue contact lens wear until symptoms resolve; consider replacement of contact lenses and case after resolution 1

When to Refer to an Ophthalmologist

• Persistent styes or those that develop into chalazia
• Suspected MRSA infections or other complicated cases 1
• Lack of response to initial treatment
• Signs of systemic illness or immunocompromised patients 1

Type-Specific Approaches

Anterior Blepharitis (affecting skin and lashes)

• Tends to be staphylococcal and/or seborrheic in nature 4
• Focus on eyelid hygiene with careful removal of crusts and scales 1

Posterior Blepharitis (affecting meibomian glands)

• May be seborrheic, obstructive, or mixed 4
• Emphasize warm compresses and vertical lid massage to express meibomian glands 1
• Consider oral antibiotics for persistent cases 1

Remember that blepharitis is often chronic and requires patient education about the long-term nature of the condition and the importance of consistent eyelid hygiene to manage symptoms effectively.