Blepharitis Treatment
The treatment for blepharitis should follow a stepwise approach, starting with warm compresses and eyelid hygiene as first-line therapy, followed by topical antibiotics for signs of infection, with oral antibiotics reserved for moderate to severe cases that don't respond to initial therapy. 1
First-line Treatment
- Warm compresses: Apply for 10-15 minutes, 3-4 times daily 1
- Eyelid hygiene: Clean eyelid margins with commercial lid scrubs or diluted baby shampoo 1
- Gentle massage: To express meibomian glands in cases of posterior blepharitis 1
Second-line Treatment
- Topical antibiotics: Add erythromycin or bacitracin ointment to the affected eyelid margins when signs of infection are present 1
- Apply 1-4 times daily depending on severity
- Standard course: 7-10 days for acute symptoms
- Intermittent therapy recommended to prevent resistance 1
Third-line Treatment
- Combination antibiotic/steroid topical treatment: Consider for moderate to severe cases with significant inflammation 1
- Note: Use steroids with caution due to potential side effects including increased intraocular pressure
Fourth-line Treatment
- Intralesional steroid injection: For persistent chalazia (>2 months) 1
- Incision and curettage: For large chalazia that don't respond to medical therapy 1
Treatment by Blepharitis Type
Anterior Blepharitis (affecting skin and lashes)
- Primarily staphylococcal and/or seborrheic in nature
- Focus on eyelid hygiene and topical antibiotics 1, 2
Posterior Blepharitis/Meibomian Gland Dysfunction
- Requires warm compresses and heat therapy to clear meibomian gland obstruction 2
- May benefit from thermal pulsation treatment in office settings 2
Special Considerations
Common Pitfalls to Avoid
- Inadequate application: Ensure proper application of medications 1
- Premature discontinuation: Complete the full course of treatment 1
- Overuse of antibiotics: Can lead to resistance 1
- Neglecting eyelid hygiene: Essential component that should be performed before applying medications 1
Contraindications and Warnings
- Tetracyclines: Contraindicated in pregnancy, nursing women, and children under 8 years 1
- Oral azithromycin: May lead to serious heart rhythm irregularities 1
- Neurotrophic corneas: Require special care to avoid corneal epithelial injury 1
Prevention of Recurrence
- Regular eyelid hygiene is crucial for preventing recurrences 1
- Complete removal of eye makeup daily 1
- Treatment of underlying conditions (rosacea, seborrheic dermatitis) 1, 3
- Discontinue contact lens wear until symptoms resolve 1
When to Refer to an Ophthalmologist
- Persistent styes (>2 weeks) 1
- Styes that develop into chalazia 1
- Suspected MRSA infections 1
- Visual changes or severe eyelid swelling 1
- Immunocompromised patients 1
- Chronic or atypical blepharitis (to rule out malignancy like sebaceous carcinoma) 1
Follow-up
- Reassess initial treatment after 2-4 weeks 1
- Provide patient education on the potentially chronic nature of the condition 1
- Adjust treatment plan based on response 1
Despite numerous studies on blepharitis treatments, the American Academy of Ophthalmology guidelines provide the most comprehensive approach, emphasizing the importance of eyelid hygiene as the foundation of treatment, with medications added as needed based on severity and response.