From the Guidelines
Topical antibiotics such as bacitracin or erythromycin ointment applied to the eyelid margins one or more times daily or at bedtime for a few weeks are recommended for the treatment of blepharitis. The use of topical antibiotics in blepharitis is supported by recent evidence, including a 2024 study published in Ophthalmology 1, which suggests that topical antibiotics can provide symptomatic relief and decrease bacteria from the eyelid margin in cases of anterior blepharitis. Some key points to consider when using topical antibiotics for blepharitis include:
- The frequency and duration of treatment should be guided by the severity of the blepharitis and response to treatment
- Topical antibiotic treatment can be repeated on an intermittent basis using different kinds of medications with different mechanisms of action to prevent the development of resistant organisms
- Alternative options, such as azithromycin in a sustained release system, have been evaluated in uncontrolled studies and appear to reduce some of the signs and symptoms of blepharitis 1
- Combination antibiotic-steroid preparations, like tobramycin-dexamethasone, may be used short-term for more severe cases, but their use should be cautious due to potential side effects, such as increased intraocular pressure 1 It is essential to accompany topical antibiotic treatment with regular lid hygiene using warm compresses and gentle lid scrubs with diluted baby shampoo or commercial lid cleansers twice daily. Additionally, patients should avoid eye makeup during treatment and discard old eye cosmetics. If symptoms persist beyond 2-3 weeks of treatment, reevaluation is necessary as chronic cases may require maintenance therapy or consideration of other conditions like demodex infestation.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: Erythromycin Topical Solution should be applied over the affected areas twice a day (morning and evening) after the skin is thoroughly washed with warm water and soap and patted dry. The topical antibiotic for the treatment of blepharitis is erythromycin 2.
- Key points:
- Apply erythromycin topical solution twice a day
- Wash the skin with warm water and soap before application
- It is used for affected areas, which may include the eyes in the case of blepharitis
From the Research
Topical Antibiotics for Blepharitis
- Azithromycin 1% ophthalmic solution is a topical antibiotic that has been proposed as a novel treatment for posterior blepharitis, based on its anti-infective profile, anti-inflammatory properties, and excellent tissue penetration 3, 4, 5
- Topical azithromycin has been shown to be effective in reducing the bacterial load and improving the clinical signs and symptoms of posterior blepharitis, including eyelid debris, eyelid redness, and meibomian gland plugging 4, 5
- Other topical antibiotics, such as erythromycin, may also be used to treat blepharitis, although there is limited evidence to support their use 6
- Topical antibiotics are often used in combination with warm compresses and eyelid hygiene to treat blepharitis, and may be used with or without topical corticosteroids 3, 4, 7
Comparison of Topical and Systemic Antibiotics
- Both topical and systemic azithromycin have been shown to be effective in improving the clinical signs and symptoms of posterior blepharitis, although topical treatment may be associated with longer cytological improvements and better stabilization of the tear film 5
- Topical antibiotics may be preferred over systemic antibiotics due to their targeted delivery and potential for higher ocular tissue concentration 5
- Systemic antibiotics, such as oral erythromycin, may be used to treat blepharitis in certain cases, such as in children or in patients with severe disease 6, 7