What is the treatment for blepharitis?

Blepharitis Treatment

The first-line treatment for blepharitis consists of daily warm compresses and eyelid cleansing, which should be maintained long-term as blepharitis is typically a chronic condition requiring ongoing management rather than expecting complete cure. 1

First-Line Treatment Approach

• Apply warm compresses to the affected eyelid(s) for 5-10 minutes, 3-4 times daily to soften crusts, warm meibomian secretions, and promote drainage 1, 2
• Clean the eyelid margins once or twice daily using diluted baby shampoo or commercially available eyelid cleaner on a cotton ball, cotton swab, or clean fingertip to remove debris and inflammatory material 1
• For posterior blepharitis/MGD (Meibomian Gland Dysfunction), perform gentle vertical eyelid massage to help express meibomian secretions 1
• Hypochlorous acid 0.01% eye cleaners can be effective due to their strong antimicrobial properties for both anterior and posterior blepharitis 1
• Artificial tears may be used to manage associated dry eye symptoms 1

Second-Line Treatment (If No Improvement After 2-4 Weeks)

• Add topical antibiotic ointment such as bacitracin or erythromycin applied to the eyelid margins one to three times daily for a few weeks 1, 3
• When applying bacitracin ointment for blepharitis, all scales and crusts should be carefully removed first, then the ointment spread uniformly over the lid margins 3
• Use antibiotics intermittently with different medications to prevent development of resistant organisms 1
• The frequency and duration of antibiotic treatment should be guided by the severity of the condition and response to treatment 1

For Persistent or Severe Cases

• Consider oral antibiotics such as doxycycline, minocycline, or tetracycline for patients with meibomian gland dysfunction whose symptoms and signs are not adequately controlled by eyelid cleansing or topical treatments 2
• For pregnant women or children under 8 years, avoid tetracyclines and consider alternatives like erythromycin or azithromycin if oral antibiotics are needed 1, 2
• Topical perfluorohexyloctane can prevent tear evaporation and improve symptoms in patients with associated dry eye disease 1
• In-office procedural treatments such as vectored thermal pulsation or microblepharoexfoliation may be considered for recalcitrant cases 1, 4

Important Considerations and Cautions

• Blepharitis is typically chronic and requires ongoing management, as symptoms often recur when treatment is discontinued 1, 5
• Avoid aggressive manipulation of the eyelid, particularly in patients with advanced glaucoma, as it may increase eye pressure 2
• Patients with neurotrophic corneas require proper counseling to avoid injury to corneal epithelium during eyelid cleaning 2
• Caution should be taken to avoid compresses that are too hot to prevent skin burns 1
• Contact lens wearers must be careful of cross-contamination between eye, lens, lens solutions, or lens cases 5
• Topical corticosteroids may provide symptomatic relief in severe cases but should be used with caution and under ophthalmological supervision 2, 6

Treatment Algorithm

1. Start with warm compresses and eyelid hygiene for 2-4 weeks 1
2. If inadequate response, add topical antibiotic ointment (bacitracin or erythromycin) 1, 3
3. For severe or resistant cases, consider oral antibiotics (tetracyclines for adults, erythromycin for children and pregnant women) 1, 2
4. For recalcitrant cases, consider in-office procedures like thermal pulsation 1, 4
5. Manage associated conditions (e.g., dry eye with artificial tears, seborrheic dermatitis, rosacea) 1, 6