What is the treatment for blepharitis (inflammation of the eyelids) due to dermatitis (skin inflammation)?

From the Guidelines

To treat blepharitis due to dermatitis, a combination of warm compresses, eyelid cleansing, and topical treatments such as artificial tears, topical perfluorohexyloctane, and topical anti-inflammatory agents like corticosteroids or cyclosporine should be used, with the goal of improving symptoms and quality of life. The treatment approach should be individualized, taking into account the severity of the condition, the patient's ability to perform eyelid cleansing, and potential triggers or underlying conditions 1.

Key Components of Treatment

• Warm compresses to soften scurf and scales or discharge and warm the meibomian secretions
• Eyelid cleansing, including gentle massage, to express meibomian glands and remove crusting from eyelashes
• Topical treatments such as artificial tears for dry eye symptoms, topical perfluorohexyloctane to prevent tear evaporation, and topical anti-inflammatory agents for inflammation
• In-office procedural treatments like vectored thermal pulsation or microblepharoexfoliation for severe cases

Considerations for Treatment

• The patient's ability to perform eyelid cleansing safely and effectively
• Potential triggers or underlying conditions that may be contributing to the blepharitis
• The need for a multidisciplinary approach, including consultation with a dermatologist, allergist, or oculoplastics specialist, in complex cases
• Regular follow-up to assess response to treatment and adjust the treatment plan as needed 1

Important Safety Considerations

• Avoiding long-term use of topical corticosteroids to prevent skin thinning and other complications
• Using topical antibiotics judiciously to avoid resistance and potential side effects
• Considering the potential risks and benefits of oral antibiotics, such as tetracyclines, and using them only when necessary and under close supervision 1

From the Research

Treatment Options for Blepharitis due to Dermatitis

The treatment for blepharitis (inflammation of the eyelids) due to dermatitis (skin inflammation) involves several approaches, including:

• Avoiding allergens that trigger the condition, as emphasized in the study 2
• Using topical medications to reduce inflammation and manage symptoms

Topical Medications

Topical tacrolimus has been shown to be effective in treating allergic contact eyelid dermatitis, with studies 3, 4, and 5 demonstrating its efficacy and safety. The medication works by inhibiting T-lymphocyte activation and dermal Langerhans' cells, without the side effects of corticosteroids.

• Tacrolimus ointment 0.1% has been used to treat moderate to severe eyelid dermatitis, with 80% of patients experiencing marked improvement or better in one study 5
• Tacrolimus ointment 0.03% has also been used to treat atopic eyelid disease, with improvement in eyelid inflammation and resolution of eczematous skin lesions and erosions within 15 days 3

Benefits and Considerations

The use of topical tacrolimus has several benefits, including:

• Effective treatment of allergic contact eyelid dermatitis and atopic eyelid disease
• Low risk of adverse effects, such as increased intraocular pressure (IOP) or cataracts
• Ability to discontinue use of topical corticosteroids, which can have negative side effects with long-term use 6 However, it is essential to note that topical tacrolimus may cause local burning and itching, especially after the first few applications 4, 5.