What is the treatment for blepharitis (blepharitis) or eyelid dermatitis?

From the Guidelines

Eyelid dermatitis treatment should prioritize a combination of warm compresses, eyelid cleansing, and topical treatments to reduce inflammation and prevent infection, as recommended by the most recent guidelines 1. The treatment of eyelid dermatitis, also known as blepharitis, involves a multi-faceted approach to manage symptoms and prevent complications.

Key Treatment Components

• Warm compresses to soften scurf and scales, and to warm the meibomian secretions
• Eyelid cleansing using gentle, fragrance-free cleansers and moisturizers to maintain the skin barrier
• Topical treatments, such as artificial tears, topical perfluorohexyloctane, and topical anti-inflammatory agents, to reduce inflammation and prevent infection

Treatment Approach

The optimal treatment regimen often requires persistence and a trial-and-error approach, with an initial step of recommending warm compresses and eyelid cleansing 1.

• Apply warm compresses to the eyelids for several minutes, several times a day
• Use gentle, fragrance-free cleansers and moisturizers to maintain the skin barrier
• Consider topical treatments, such as artificial tears, topical perfluorohexyloctane, and topical anti-inflammatory agents, to reduce inflammation and prevent infection

Additional Considerations

• Avoid known irritants, such as makeup, certain skincare products, and allergens
• If symptoms include severe itching, an oral antihistamine like cetirizine 10mg daily may provide relief
• For cases with suspected infection, your doctor might prescribe antibiotic ointments
• If symptoms persist beyond 2 weeks of treatment or worsen with redness, swelling, or discharge, consult a dermatologist as you may need patch testing to identify specific allergens or different treatment approaches 1.

From the Research

Eyelid Dermatitis Treatment Options

• The treatment of eyelid dermatitis involves identifying and avoiding the causative allergens, with an emphasis on patient counseling 2.
• Topical corticosteroids are often used to facilitate the resolution of associated inflammation, but their use should be limited due to the risk of adverse effects such as atrophy, striae, and rosacea 3, 4.
• Tacrolimus ointment has been shown to be a promising alternative in the treatment of allergic contact eyelid dermatitis, with studies demonstrating its efficacy and tolerability 5, 6.

Management Strategies

• Identification and elimination of causative agents is the mainstay of management for allergic eyelid dermatitis 3.
• Patients who are resistant to therapy may benefit from formal allergy testing, such as patch testing 3.
• Topical tacrolimus can be used as an alternative to corticosteroids, especially in patients with open-angle glaucoma who are at risk of increased intraocular pressure with corticosteroid use 6.

Treatment Considerations

• The choice of topical corticosteroid should be based on the strength and risk of adverse effects, with lower potencies and shorter durations recommended for use in children 4.
• Correct patient application is critical to successful use, and patients can be taught to apply topical corticosteroids using the fingertip unit method 4.
• The quantity of corticosteroid prescribed depends on the duration of treatment, frequency of application, skin location, and total surface area treated 4.