From the Guidelines
Eyelid allergies, also known as blepharitis, can be effectively managed with a combination of warm compresses, eyelid cleansing, and topical treatments, as recommended by the most recent guidelines 1.
Treatment Options
The following treatment options may be helpful:
- Warm compresses to soften adherent scurf and scales or discharge and/or warm the meibomian secretions
- Eyelid cleansing, including eyelid massage in cases of meibomian gland dysfunction (MGD) to express the meibomian glands
- Topical perfluorohexyloctane
- Antibiotics (topical and/or systemic)
- Antiparasitic medication (metronidazole, ivermectin, lotilaner)
- Topical anti-inflammatory agents (e.g., corticosteroids, cyclosporine)
Recommended Approach
I recommend starting with warm compresses and eyelid cleansing, which may be accomplished in several ways, as outlined in the most recent guidelines 1.
- Apply warm compresses to the eyelids for several minutes to soften adherent scurf and scales or discharge and/or warm the meibomian secretions
- Use eye cleaners with hypochlorous acid at 0.01% for their strong antimicrobial effect
- Perform vertical eyelid massage to express meibomian secretions
- Rub the eyelid margins from side to side to remove crusting from the eyelashes
Important Considerations
It is essential to instruct patients to avoid using compresses that are so hot that they burn the skin. Additionally, proper counseling of patients with neurotrophic corneas is crucial to avoid injury to the corneal epithelium. A schedule of regularly performed eyelid cleansing, daily or several times weekly, can help blunt the symptoms of chronic blepharitis.
Additional Treatments
Other treatments, such as topical anti-inflammatory agents and antibiotics, may be necessary in some cases, as outlined in the guidelines 1. However, the optimal treatment regimen often requires persistence and a trial-and-error approach.
Consultation
If symptoms persist beyond 1-2 weeks of treatment or if you experience eye pain or vision changes, consult an eye care professional as you may need stronger prescription treatments or have a different condition.
From the Research
Eyelid Allergies
- Eyelid allergies can be a symptom of allergic conjunctivitis, which can be treated with various medications, including antihistamines, mast cell stabilizers, and corticosteroids 2.
- Topical antihistamines, such as ketotifen, olopatadine, and azelastine, can provide fast and effective relief for allergic conjunctivitis symptoms, including eyelid allergies 2, 3.
- Ketotifen, in particular, has been shown to be highly effective in reducing symptoms of seasonal allergic conjunctivitis, with a faster onset of action compared to other medications like emedastine 3, 4.
- Allergen immunotherapy, including subcutaneous and sublingual immunotherapy, can also be used to treat allergic conjunctivitis and may provide long-term relief from symptoms, including eyelid allergies 5.
Treatment Options
- Topical antihistamines:
- Mast cell stabilizers:
- Sodium cromoglicate and nedocromil can help reduce symptoms of allergic conjunctivitis, but may have a slower onset of action compared to antihistamines 2.
- Corticosteroids:
- Topical corticosteroids may be used to treat severe seasonal ocular allergy symptoms, but long-term use should be avoided due to risks of ocular adverse effects 2.
Efficacy and Safety
- Ketotifen 0.025% has been shown to be more effective and better tolerated than 0.05% in treating seasonal allergic conjunctivitis 3.
- Allergen immunotherapy, including subcutaneous and sublingual immunotherapy, can provide improvement in allergic conjunctival symptom scores and decrease medication utilization, but may have adverse effects and varying rates of adherence 5.