From the Guidelines
Blepharitis is a chronic condition that cannot be permanently cured, but its symptoms can be significantly improved with daily eyelid hygiene and treatment, prioritizing warm compresses, artificial tears, and eyelid cleansing, as recommended in the most recent guidelines 1. To diagnose blepharitis, it is essential to distinguish between anterior and posterior blepharitis, with the latter involving meibomian gland dysfunction (MGD) 2. The condition typically presents with redness, irritation, and crusting around the eyelashes, and its management depends on the patient's compliance with the treatment regimen.
Treatment Approach
The treatment approach for blepharitis involves a combination of the following:
- Daily eyelid hygiene using warm compresses for 5-10 minutes to loosen debris, followed by gentle cleansing of the eyelid margins with diluted baby shampoo or commercial eyelid cleansers like OCuSOFT or SteriLid 1
- Artificial tears to help relieve associated dry eye symptoms 1
- Topical antibiotics, such as erythromycin or bacitracin, to apply to the eyelid margins at bedtime for 7-10 days for moderate cases 3
- Oral antibiotics, like doxycycline 100mg twice daily for 2-4 weeks, or anti-inflammatory medications for severe or persistent cases 3
- In-office procedures targeting the meibomian glands, which have shown efficacy in some studies, although more research is needed to demonstrate superiority over other treatments 2
Important Considerations
It is crucial to address underlying conditions like seborrheic dermatitis or rosacea, which may also help manage blepharitis more effectively 1. Additionally, patients should be aware of the potential risks and side effects associated with certain treatments, such as oral azithromycin, which may produce cardiac arrhythmias in patients with cardiovascular problems 2.
Ongoing Maintenance
Blepharitis is often chronic and requires ongoing maintenance with regular lid hygiene to prevent recurrence 1. Patients should be advised to continue with daily eyelid hygiene and treatment as recommended by their doctor to manage symptoms and prevent further complications.
From the Research
Diagnosis of Blepharitis
- Blepharitis is a chronic inflammatory disease of the eyelids that can be classified into anterior blepharitis, involving the anterior lid margin and eyelashes, and posterior blepharitis, characterized by dysfunction of the meibomian glands 4
- The condition is characterized by inflammation of the eyelid margin and can cause discomfort and irritation among people of all ages, ethnicity, and sex 5
- Blepharitis can present with a range of signs and symptoms, and is associated with various dermatological conditions, namely, seborrheic dermatitis, rosacea, and eczema 6
Treatment of Blepharitis
- The mainstay of treatment is an eyelid hygiene regimen, which needs to be continued long term 6
- Topical antibiotics are used to reduce the bacterial load, and topical corticosteroid preparations may be helpful in patients with marked inflammation 6, 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
- For anterior blepharitis, management options include eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers, accompanied by topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid 7
- For posterior blepharitis/meibomian gland dysfunction (MGD), at-home warm compress or in-office administration of heat therapy/thermal pulsation treatment is recommended to clear obstruction in the meibomian glands and restore meibum secretions to maintain a healthy tear film 7
- A combination of remedial measures that addresses eyelids hygiene and includes medicated and device therapy is considered the most effective method of treating chronic blepharitis 8