What is the treatment for eyelid inflammation?

Treatment of Eyelid Inflammation (Blepharitis)

The first-line treatment for eyelid inflammation (blepharitis) consists of daily warm compresses and eyelid cleansing with diluted baby shampoo or commercial eyelid cleaner to remove debris and crusting from the eyelashes. 1, 2

Types of Blepharitis

• Anterior blepharitis affects the eyelid skin, base of eyelashes, and follicles 2
• Posterior blepharitis (Meibomian Gland Dysfunction or MGD) affects the meibomian glands 2

First-Line Treatment Approach

• Apply warm compresses to soften crusts and warm meibomian secretions once or twice daily 1, 2
• Clean eyelids by gently rubbing the base of eyelashes using diluted baby shampoo or commercial eyelid cleaner on a cotton ball, pad, swab, or clean fingertip 1, 2
• For posterior blepharitis/MGD, perform vertical eyelid massage to help express meibomian secretions 2
• Hypochlorous acid 0.01% eye cleaners have strong antimicrobial effects for both anterior and posterior blepharitis 2
• Artificial tears can help manage associated dry eye symptoms 2

Second-Line Treatment: Topical Antibiotics

• If inadequate response to eyelid hygiene after 2-4 weeks, add topical antibiotic ointment 1, 2
• Bacitracin or erythromycin ointment applied to eyelid margins one or more times daily for a few weeks 1
• Topical antibiotics provide symptomatic relief and decrease bacteria from the eyelid margin in anterior blepharitis 1
• Rotate different antibiotics to prevent development of resistant organisms 1
• Topical tobramycin/dexamethasone or azithromycin may reduce signs and symptoms of blepharitis (off-label use) 1

Third-Line Treatment: Oral Antibiotics

• For moderate to severe cases not responding to topical treatment, especially with MGD 1
• Doxycycline, minocycline, or tetracycline can be given daily and tapered after clinical improvement 1
• For women of childbearing age and children under 8 years, oral erythromycin or azithromycin should be used instead of tetracyclines 1
• Suggested dosing for erythromycin in children: 30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks 1
• Pediatric dosing for azithromycin: 5 mg/kg daily for 2 months 1
• Adult dosing for pulsed oral azithromycin: 500 mg per day for 3 days in three cycles with 7-day intervals, or 1 g per week for 3 weeks 1

Role of Topical Corticosteroids

• A brief course of topical corticosteroids may help control eyelid or ocular surface inflammation 1
• Apply several times daily to eyelids or ocular surface, then taper and discontinue once inflammation is controlled 1
• Use minimal effective dose and avoid long-term therapy 1
• Consider site-specific corticosteroids like loteprednol etabonate or those with limited ocular penetration like fluorometholone phosphate to minimize adverse effects 1

Important Considerations

• Complete cure is usually not possible; long-term management is required 2
• Symptoms often recur when treatment is discontinued 1, 2
• Frequency and duration of treatment should be guided by severity of blepharitis and response to treatment 1, 2
• Caution with warm compresses to avoid burns 2
• Tetracyclines have contraindications: pregnancy, nursing women, children under 8 years, hypersensitivity 1
• Tetracyclines can cause photosensitization, GI upset, vaginitis, and rarely azotemia 1

For Persistent or Severe Cases

• In-office procedural treatments such as vectored thermal pulsation or microblepharoexfoliation 2
• Topical cyclosporine may help some patients with posterior blepharitis 1
• Topical perfluorohexyloctane can prevent tear evaporation and improve symptoms with associated dry eye 2

Patient Education

• Blepharitis is typically chronic and requires ongoing management 2
• Daily eyelid hygiene is essential for long-term control 2
• Treatment may need to be continued indefinitely, with frequency adjusted based on symptom control 1