Treatment for Eyelids Sticking Together
The primary treatment for eyelids sticking together is warm compresses applied for 5-10 minutes once or twice daily, followed by gentle eyelid cleansing with diluted baby shampoo or hypochlorous acid (0.01%) cleaners, combined with topical antibiotic ointment (bacitracin or erythromycin) applied to the eyelid margins. 1, 2, 3
Initial Conservative Management
The cornerstone of treatment addresses the underlying meibomian gland dysfunction and blepharitis that typically causes eyelid adhesion:
Apply warm compresses to the eyelids for several minutes to soften adherent discharge and warm meibomian secretions—use hot tap water on a clean washcloth, over-the-counter heat packs, or microwaveable bean/rice bags, ensuring the compress is not hot enough to burn the skin 1
Perform eyelid cleansing immediately after warm compresses by gently rubbing the base of the eyelashes using diluted baby shampoo or commercially available eyelid cleaners on a cotton ball, cotton swab, or clean fingertip 1
Use hypochlorous acid cleaners (0.01%) which have strong antimicrobial effects and are effective for treating both anterior and posterior blepharitis that causes eyelid sticking 1, 4
Apply vertical eyelid massage to express meibomian gland secretions, and rub the eyelid margins side to side to remove crusting from the eyelashes 1
Topical Antibiotic Therapy
When inflammation or bacterial involvement is present:
Bacitracin ointment should be applied directly to the eyelid margins 1-3 times daily after removing all scales and crusts, spreading uniformly over the lid margins 1, 2
Erythromycin ointment (approximately 1 cm in length) can be applied to the affected eye(s) up to six times daily depending on severity 1, 3
Topical antibiotic treatment can be repeated intermittently using different medications to prevent resistant organism development 1
Additional Supportive Measures
Artificial tears help manage associated dry eye symptoms that may accompany eyelid inflammation 1, 4
Topical perfluorohexyloctane prevents tear evaporation and improves comfort in patients with concurrent dry eye 1, 4
Treatment must be performed regularly (daily or several times weekly) as symptoms often recur when discontinued 1
Important Clinical Caveats
Patients with advanced glaucoma should avoid aggressive pressure on the lids during massage, as this may increase intraocular pressure 1, 4
Patients with neurotrophic corneas require proper counseling to avoid corneal epithelial injury during eyelid cleansing 1, 4
Patients lacking manual dexterity or necessary skill should have the therapeutic plan tailored accordingly, as improper technique can be dangerous 1
When to Escalate Treatment
For cases not adequately controlled by eyelid hygiene alone:
Oral tetracyclines (doxycycline, minocycycline, or tetracycline) can be given daily and tapered after clinical improvement for patients with meibomian gland dysfunction 1
Oral erythromycin or azithromycin are alternatives, especially in women of childbearing age and children 1
Surgical management may be necessary in severe cases with associated lower lid laxity, reverse ptosis, or dermatochalasis that contribute to the adhesion 5
The American Academy of Ophthalmology emphasizes that patients must understand a cure is usually not possible, but continual daily treatment can significantly improve symptoms 1. The optimal regimen requires persistence and a trial-and-error approach, with frequency and duration guided by severity and response to treatment 1.