From the Guidelines
Blepharitis management involves a combination of treatments, with the primary goal of alleviating symptoms, as a cure is usually not possible.
Key Treatment Options
- Warm compresses: applied to the eyelids for several minutes to soften adherent scurf and scales or discharge and/or warm the meibomian secretions 1
- Eyelid cleansing: including eyelid massage in cases of meibomian gland dysfunction (MGD) to express the meibomian glands, which can be accomplished by brief, gentle massage of the eyelids or using eye cleaners with hypochlorous acid at 0.01% 1
- Artificial tears: especially those containing oil or lipid-based products, to improve symptoms when used as an adjunct to eyelid cleansing and medications 1
- Topical antibiotics: such as bacitracin or erythromycin, which can be prescribed and applied on the eyelid margins one or more times daily or at bedtime for a few weeks 1
- Topical anti-inflammatory agents: such as corticosteroids, which can be helpful for eyelid or ocular surface inflammation, but should be used with caution due to potential adverse effects 1
Additional Considerations
- Oral antibiotics: such as azithromycin, which may be effective in the treatment of blepharitis, but can produce cardiac arrhythmias when used orally in patients with cardiovascular problems 1
- Diet modification: and dietary supplementation with essential fatty acids, which may be beneficial in managing blepharitis, although more studies are needed to clearly define their role 1
- In-office procedural treatments: such as vectored thermal pulsation and microblepharoexfoliation, which may be helpful in some cases of blepharitis, but lack robust evidence to support their routine recommendation 1
From the Research
Management of Blepharitis
The management of blepharitis involves a combination of treatments aimed at reducing symptoms and preventing complications. The following are some of the management options for blepharitis:
- Eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers 2, 3, 4, 5
- Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid 2, 3, 4
- Heat therapy/thermal pulsation treatment to clear obstruction in the meibomian glands and restore meibum secretions 2
- Systemic antibiotics may be appropriate in some patients 3
- Topical corticosteroid preparations may be helpful in patients with marked inflammation 3, 4
- Fixed combinations of a topical antibiotic and a corticosteroid offer an effective and convenient treatment modality that addresses both infectious and inflammatory components of the disease 4
Treatment Approach
The treatment approach for blepharitis may vary depending on the cause, location, and severity of the disease. A stepwise approach to diagnosis, treatment, and management is recommended 6. The mainstay of treatment is an eyelid hygiene regimen, which needs to be continued long term 3.
Long-term Management
Long-term management of symptoms may include daily eyelid cleansing routines and the use of therapeutic agents that reduce infection and inflammation 4, 5. A cure is not possible in most cases, and subjective symptoms may persist even when a clinical assessment of signs indicates that the condition has improved 4.