What is the treatment for blepharitis?

Treatment for Blepharitis

The first-line treatment for blepharitis is warm compresses (10-15 minutes, 3-4 times daily) combined with eyelid hygiene and gentle massage. 1

Step-wise Treatment Approach

First-line Treatment

• Warm compresses: Apply for 10-15 minutes, 3-4 times daily
• Eyelid hygiene: Carefully remove all scales and crusts
• Gentle massage: To express meibomian glands

Second-line Treatment

• Add topical antibiotics for signs of infection or risk of secondary infection:
  • Bacitracin or erythromycin ointment
  • Application: Apply directly into the conjunctival sac 1 to 3 times daily 2
  • For blepharitis specifically: Spread uniformly over lid margins after removing scales and crusts 2

Third-line Treatment

• Consider combination antibiotic/steroid topical treatment for moderate to severe cases 1

Fourth-line Treatment

• Consider intralesional steroid injection or incision and curettage for persistent (>2 months) or large chalazia 1

Treatment Based on Type of Blepharitis

Anterior Blepharitis (Staphylococcal and/or Seborrheic)

• Eyelid hygiene with warm compresses
• Eyelid scrubs
• Baby shampoo or over-the-counter eyelid cleansers
• Topical antibiotics 3

Posterior Blepharitis/Meibomian Gland Dysfunction (MGD)

• At-home warm compresses
• In-office heat therapy/thermal pulsation treatment to clear meibomian gland obstruction 3

Demodex Blepharitis

• Tea tree oil treatment if Demodex mites are present 1
• Lotilaner ophthalmic solution 0.25% has shown effectiveness in eradicating Demodex mites and eliminating collarettes and eyelid redness 4, 5

Additional Treatment Options for Severe or Unresponsive Cases

• Oral antibiotics:

  • Tetracycline antibiotics (doxycycline)
  • Oral macrolides 1

• Decolonization strategies for recurrent styes:

  • Nasal decolonization with mupirocin twice daily for 5-10 days
  • Topical body decolonization with chlorhexidine antiseptic solution for 5-14 days
  • Dilute bleach baths (1 teaspoon per gallon of water, 15 minutes twice weekly for 3 months) 1

Prevention of Recurrence

• Maintain good eyelid hygiene
• Remove eye makeup completely
• Treat underlying conditions (rosacea, seborrheic dermatitis, etc.)
• Discontinue contact lens wear until symptoms resolve 1
• Dietary modifications: Mediterranean diet may be beneficial 1
• Environmental considerations:
  • Avoid excess dryness, wind, and air-conditioned environments
  • Increase blinking frequency (>10 times/minute) when using computers or watching TV 1

Important Clinical Considerations

• Blepharitis is often a chronic condition requiring long-term management 6
• Patient education is crucial regarding the potentially chronic nature of the condition
• Reassessment after 2-4 weeks to evaluate treatment response 1
• Limit preservative-containing artificial tears to ≤4 times/day; use preservative-free options for more frequent use 1
• Topical steroids should be used short-term only unless the patient has autoimmune disease or moderate to severe dry eye disease 1

When to Refer to a Specialist

Refer patients with:

• Visual changes
• Corneal involvement
• Severe eyelid swelling unresponsive to initial treatment
• Suspected malignancy
• Cicatricial changes in the conjunctiva 1

When to Consider Biopsy

Consider biopsy for cases with:

• Marked asymmetry between eyes
• Resistance to standard therapy
• Unifocal recurrent chalazia
• Loss of normal eyelid margin anatomy
• Focal lash loss (madarosis) 1