From the Guidelines
Blepharitis treatment should start with warm compresses applied to closed eyelids for 5-10 minutes twice daily, followed by gentle lid scrubs using diluted baby shampoo or commercial eyelid cleansers, as this approach has been shown to significantly improve symptoms 1.
Treatment Approach
The treatment of blepharitis involves a combination of eyelid hygiene and medications.
- Warm compresses can be applied using hot tap water on a clean washcloth, over-the-counter heat pack, or homemade bean/rice bag that can be heated in the microwave 1.
- Eyelid cleansing can be accomplished by brief, gentle massage of the eyelids, and eye cleaners with hypochlorous acid at 0.01% have a strong antimicrobial effect 1.
- Topical antibiotics like erythromycin or bacitracin ointment can be applied to the lid margins at bedtime for 7-10 days to control bacterial infection in anterior blepharitis 2.
- Posterior blepharitis (meibomian gland dysfunction) may require oral antibiotics such as doxycycline 100mg daily for 6-12 weeks, which has anti-inflammatory properties beyond its antimicrobial effects 2.
Additional Considerations
- Artificial tears can provide symptomatic relief for associated dry eye 1.
- Omega-3 fatty acid supplements (1000-2000mg daily) may improve meibomian gland function over time 1.
- Blepharitis is typically chronic, so maintenance therapy with regular lid hygiene is essential even after symptoms improve 1.
- Addressing underlying conditions like rosacea or seborrheic dermatitis is also important for long-term management 1.
- Patients should avoid eye makeup during acute flares and replace eye cosmetics every 3-6 months to prevent contamination 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: The ointment should be applied directly into the conjunctival sac 1 to 3 times daily. In blepharitis all scales and crusts should be carefully removed and the ointment then spread uniformly over the lid margins. For the treatment of blepharitis, bacitracin ophthalmic ointment should be applied directly into the conjunctival sac 1 to 3 times daily, with careful removal of all scales and crusts before applying the ointment uniformly over the lid margins 3.
From the Research
Treatment Options for Blepharitis
- The treatment modalities for managing lid margin diseases vary depending on the disease's cause, location, and severity 4.
- For anterior blepharitis, management options include eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers 4.
- Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid may accompany these treatments 4, 5.
- For posterior blepharitis/meibomian gland dysfunction (MGD), at-home warm compress or in-office administration of heat therapy/thermal pulsation treatment is recommended 4.
- Systemic antibiotics may be appropriate in some patients, such as children with blepharokeratitis, where oral erythromycin has been shown to be effective 6.
Effectiveness of Treatments
- Topical antibiotics have been shown to provide some symptomatic relief and are effective in eradicating bacteria from the eyelid margin for anterior blepharitis 7.
- Lid hygiene may provide symptomatic relief for anterior and posterior blepharitis 7.
- The effectiveness of other treatments for blepharitis, such as topical steroids and oral antibiotics, is inconclusive 7.
- There is no strong evidence for any of the treatments in terms of curing chronic blepharitis, and further research is needed to evaluate the effectiveness of such treatments 7.
Management and Diagnosis
- The mainstay of treatment is an eyelid hygiene regimen, which needs to be continued long term 5.
- Blepharitis can present with a range of signs and symptoms, and its management can be complicated by a number of factors 5, 8.
- Expert clinical recommendations and a review of the evidence on treatment support the practice of careful lid hygiene, possibly combined with the use of topical antibiotics, with or without topical steroids 5.