Treatment for Infected Eyelid (Blepharitis)
The treatment for an infected eyelid (blepharitis) should begin with warm compresses and eyelid cleansing, followed by topical antibiotics for anterior blepharitis, and possibly oral antibiotics for more severe or persistent cases. 1
First-Line Treatment
Eyelid Hygiene
- Apply warm compresses to the eyelids for several minutes to soften adherent debris and warm meibomian secretions 1
- Follow with gentle eyelid cleansing using either diluted baby shampoo or commercially available eyelid cleaners on a cotton ball, pad, swab, or clean fingertip 1
- Eye cleaners with 0.01% hypochlorous acid have strong antimicrobial effects for both anterior and posterior blepharitis 1
- Perform once or twice daily, with treatment likely needed long-term as symptoms often recur when discontinued 1
Topical Antibiotics
- Apply antibiotic ointment such as bacitracin or erythromycin to the eyelid margins one or more times daily or at bedtime for a few weeks 1
- Rotate different antibiotics with different mechanisms of action to prevent development of resistant organisms 1
- Adjust frequency and duration based on severity of infection and response to treatment 1
Second-Line Treatment
Oral Antibiotics
- Consider for patients whose chronic symptoms and signs are not adequately controlled by eyelid cleansing or topical antibiotics 1
- Options include:
- Tetracyclines (doxycycline, minocycline) - effective for meibomian gland dysfunction (MGD) 1
- Macrolides (erythromycin, azithromycin) - particularly for women of childbearing age and children under 8 years 1
- Cephalexin (250-500 mg orally 4 times daily for 7-14 days) when Staphylococcal infection is suspected 2
- Taper after clinical improvement is noted 1
Anti-inflammatory Agents
- Topical corticosteroids may be used short-term for significant inflammation 1
- Combination products like tobramycin/dexamethasone provide both antimicrobial coverage and anti-inflammatory effects 2
- Use with caution in patients with advanced glaucoma 2
Special Considerations
Monitoring Treatment Response
- Look for reduced pain, decreased eyelid edema, reduced conjunctival injection, and decreased crusting 1
- If no improvement within 48 hours of starting treatment, consider modifying therapy 1
Cautions
- Avoid aggressive lid pressure in patients with advanced glaucoma 1
- Tetracyclines are contraindicated in pregnancy, nursing women, and children under 8 years 1
- Tetracyclines can cause photosensitization, gastrointestinal upset, and rarely, azotemia 1
- Prolonged use of topical antibiotics can cause toxicity and development of resistant organisms 1
Patient Education
- Inform patients that blepharitis is often chronic and requires ongoing management 1
- Emphasize the importance of consistent eyelid hygiene even after acute symptoms resolve 1
- Warn that warm compresses should not be so hot as to burn the skin 1
By following this treatment algorithm, most cases of infected eyelids can be effectively managed, reducing symptoms and preventing complications while minimizing the risk of antibiotic resistance.