From the Guidelines
Blepharitis treatment should start with twice-daily warm compresses for 5-10 minutes to loosen debris, followed by gentle lid scrubs using diluted baby shampoo or commercial eyelid cleansers, as this approach has been shown to improve symptoms and quality of life 1. The treatment of blepharitis involves a combination of eyelid hygiene and medications.
- Warm compresses can be applied to the eyelids for several minutes to soften adherent scurf and scales or discharge and/or warm the meibomian secretions, with sustained warmth 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 1.
- Eyelid cleansing can be accomplished by brief, gentle massage of the eyelids, with eye cleaners with hypochlorous acid at 0.01% having a strong antimicrobial effect, which has been used for the treatment of both anterior and posterior blepharitis 1.
- Topical treatments, such as topical perfluorohexyloctane, topical antibiotics, and topical anti-inflammatory agents, may be helpful in reducing symptoms and improving quality of life 1.
- Oral antibiotics, such as doxycycline, may be used in patients with meibomian gland dysfunction (MGD) whose chronic symptoms and signs are not adequately controlled by eyelid cleansing or meibomian gland expression 1.
- Patients should avoid eye makeup during acute flares and replace eye cosmetics every 3-6 months, and underlying conditions like rosacea or seborrheic dermatitis should be addressed 1.
- Blepharitis is often chronic, requiring ongoing maintenance therapy with lid hygiene to prevent recurrence, as the condition results from bacterial overgrowth, meibomian gland dysfunction, and inflammatory processes affecting the eyelid margins 1.
- The optimal treatment regimen often requires persistence and a trial-and-error approach, with the ophthalmologist considering the patient’s ability to perform the treatment and tailoring the therapeutic plan accordingly 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 [ 2 ]
From the Research
Treatment Options for Blepharitis
- The treatment for blepharitis often involves a combination of remedial measures that address eyelid hygiene and include medicated and device therapy 3.
- Treatment modalities for managing lid margin diseases vary depending on the disease's cause, location, and severity 4.
- For anterior blepharitis, management options include:
- Eyelid hygiene with warm compresses
- Eyelid scrubs
- Baby shampoo
- Over-the-counter eyelid cleansers
- Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid 4
- For posterior blepharitis/meibomian gland dysfunction (MGD), treatment options include:
- 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 to maintain a healthy tear film 4
- Additional treatment strategies may include:
- Topical corticosteroid preparations to reduce inflammation 5
- Systemic antibiotics in some patients 5
- Azithromycin ophthalmic solution 1% in DuraSite for the treatment of posterior blepharitis 6
- Fixed combinations of a topical antibiotic and a corticosteroid to address both infectious and inflammatory components of the disease 7