Treatment of Blepharitis in Children
The recommended first-line treatment for blepharitis in children is eyelid hygiene with warm compresses and gentle cleansing, followed by topical antibiotics such as bacitracin or erythromycin ointment for anterior blepharitis, and oral erythromycin or azithromycin for more severe cases with posterior involvement. 1, 2
First-Line Treatment Approach
- Begin with daily eyelid hygiene, which is essential for both anterior and posterior blepharitis 1, 2
- Apply warm compresses for several minutes to soften adherent material and warm meibomian secretions 1
- Perform gentle eyelid cleansing and massage using diluted baby shampoo or commercially available eyelid cleaners 2
- Hypochlorous acid 0.01% eye cleaners have antimicrobial effects for both anterior and posterior blepharitis 1, 2
Antibiotic Treatment
- For anterior blepharitis that doesn't respond to hygiene measures alone, apply topical antibiotic ointment such as bacitracin or erythromycin to eyelid margins once or more times daily for a few weeks 1, 2
- For children with posterior blepharitis or more severe cases, oral erythromycin is recommended at a dosage of 30-40 mg/kg divided over 3 doses for 3 weeks, then twice daily for 4-6 weeks 3
- Alternatively, azithromycin at 5 mg/kg daily for 2 months has shown clinical improvement in children with blepharitis 3
- Tetracyclines should not be used in children under 8 years of age due to the risk of dental staining 3
Management of Severe or Persistent Cases
- For severe cases with corneal involvement, which accounts for approximately 5% of pediatric blepharitis cases, topical corticosteroids may be considered for short-term use (1-2 weeks) 1, 4
- Consider rotating different antibiotics to prevent development of resistant organisms 1, 2
- For persistent symptoms, artificial tears can help manage associated dry eye symptoms 2
Important Considerations for Pediatric Patients
- Blepharitis is common in children, with one study showing it accounts for 12% of pediatric ophthalmology consultations 4
- Boys appear to be more commonly affected (62%) than girls 4
- Anterior blepharitis (seborrheic variety) is more common in children than posterior blepharitis 4
- Treatment compliance may be challenging in children, requiring parental assistance with eyelid hygiene and medication administration 5
- Refractive errors are common in children with blepharitis (85% in one study), suggesting the importance of comprehensive eye examination 4
Treatment Duration and Expectations
- Blepharitis is typically chronic and requires ongoing management; patients and parents should understand that complete cure is usually not possible 1, 2
- Most children experience symptomatic relief within 2-3 weeks of starting appropriate therapy, though clinical signs may take longer to resolve 6
- Reactivation is common, and repeat therapy is often necessary 6
- The frequency and duration of treatment should be guided by the severity of the blepharitis and response to treatment 3
Limitations of Evidence
- A Cochrane systematic review has reported uncertainty regarding the effectiveness of both topical and systemic treatments for blepharokeratoconjunctivitis in children due to lack of high-quality evidence 3, 1
- More clinical trials are needed to establish safety and efficacy for the proper treatment of blepharokeratoconjunctivitis in children 3
Despite limited high-quality evidence specifically in children, the combination of eyelid hygiene, topical antibiotics for anterior blepharitis, and oral erythromycin or azithromycin for more severe cases remains the most appropriate approach based on current guidelines and available research.