From the Guidelines
Blepharitis is typically treated with a combination of warm compresses, eyelid cleansing, and topical medications, as a cure is usually not possible, but these treatments can significantly improve symptoms.
Treatment Options
- Warm compresses: applied to the eyelids for several minutes to soften adherent scurf and scales or discharge and/or warm the meibomian secretions 1
- Eyelid cleansing: including eyelid massage in cases of meibomian gland dysfunction (MGD) to express the meibomian glands, which can be accomplished by brief, gentle massage of the eyelids or using eye cleaners with hypochlorous acid at 0.01% 1
- Topical medications: such as antibiotics (e.g., azithromycin), anti-inflammatory agents (e.g., corticosteroids, cyclosporine), and artificial tears 1
Additional Therapies
- In-office procedural treatments: such as vectored thermal pulsation, microblepharoexfoliation, and intense pulsed light (IPL) therapy, which have shown efficacy in some studies, but more research is needed to determine their effectiveness 1
- Oral antibiotics: such as doxycycline, which may be effective in treating blepharitis, but may cause more adverse events 1
- Diet modification: and omega-3 supplements, which may have a potential benefit in managing blepharitis, but more studies are needed to clearly define their role 1 It is essential to note that the optimal treatment regimen often requires persistence and a trial-and-error approach, and patients should be informed that a cure is usually not possible, but continual daily treatment can significantly improve symptoms 1.
From the Research
Treatment Options for Blepharitis
The treatment for blepharitis typically involves a combination of eyelid hygiene, topical antibiotics, and topical corticosteroids. The mainstay of treatment is an eyelid hygiene regimen, which needs to be continued long term 2. This may include warm compresses, eyelid scrubs, and baby shampoo or over-the-counter eyelid cleansers 3.
Topical Treatments
Topical antibiotics are used to reduce the bacterial load, and topical corticosteroid preparations may be helpful in patients with marked inflammation 2, 4. Azithromycin ophthalmic solution 1% in DuraSite has been proposed as a novel treatment for posterior blepharitis, based on its anti-infective profile, anti-inflammatory properties, and excellent tissue penetration 4.
Systemic Treatments
Oral antibiotics may be used to treat chronic blepharitis, particularly in cases with severe inflammation or meibomian gland dysfunction 5. However, the evidence for the effectiveness of oral antibiotics is very uncertain, and further trials are needed to provide high-quality evidence on their use in treating chronic blepharitis 5.
Additional Therapies
Other treatment modalities, such as heat therapy or thermal pulsation treatment, may be used to clear obstruction in the meibomian glands and restore meibum secretions to maintain a healthy tear film 3. Device therapy may also be used in combination with medicated therapy to treat chronic blepharitis 6.
Key Points
- Eyelid hygiene is the mainstay of treatment for blepharitis
- Topical antibiotics and corticosteroids may be used to reduce bacterial load and inflammation
- Oral antibiotics may be used in severe cases, but evidence for their effectiveness is uncertain
- Additional therapies, such as heat therapy or device therapy, may be used to treat meibomian gland dysfunction and maintain a healthy tear film 2, 6, 3, 4, 5