What is the treatment for blepharitis (inflammation of the eyelid)?

From the Guidelines

Eyelid infections can typically be treated at home with warm compresses and gentle eyelid cleansing, and in some cases, may require topical or oral antibiotics, as recommended in the most recent guidelines 1. The treatment of eyelid infections, such as blepharitis, involves a combination of warm compresses, eyelid cleansing, and potentially, topical or oral antibiotics.

Treatment Options

• Warm compresses can be applied to the affected eye for 10-15 minutes, 3-4 times daily, to soften crusts and drain the infection.
• Gently cleaning the eyelids with diluted baby shampoo or commercial eyelid cleansers, such as those containing hypochlorous acid, can help reduce bacterial load and inflammation.
• Topical antibiotics, such as erythromycin or bacitracin, can be applied to the eyelid margin after cleaning to treat bacterial infections.
• In severe or persistent cases, prescription antibiotics like azithromycin eye drops or oral doxycycline (100mg twice daily for 7-10 days) may be necessary.

Important Considerations

• It is essential to avoid wearing contact lenses and eye makeup during the infection to prevent further irritation and potential complications.
• If the infection causes significant pain, redness spreading beyond the eyelid, vision changes, or does not improve within a week, medical attention should be sought immediately.
• Good eyelid hygiene should be continued even after symptoms resolve to prevent recurrence, as recommended in the blepharitis preferred practice pattern 1.
• The use of topical perfluorohexyloctane, which was FDA approved in 2023, may also be beneficial in preventing tear evaporation and improving symptoms in patients with dry eye disease 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.

• Bacitracin ophthalmic ointment can be used to treat eyelid infections, specifically blepharitis.
• The ointment should be applied 1 to 3 times daily, with scales and crusts removed before application.
• It is essential to avoid contamination of the ointment when applying it to the infected eye 2.

From the Research

Treatment of Eyelid Infection

• The treatment of eyelid infections, such as conjunctivitis, can be managed conservatively, with antibiotics prescribed either after a delayed period if symptoms do not improve within 3 days of onset, or not at all 3.
• Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment, while bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks 4.
• Topical antibiotics can decrease the duration of bacterial conjunctivitis and allow earlier return to school or work, but the majority of cases in bacterial conjunctivitis are self-limiting and no treatment is necessary in uncomplicated cases 4.
• Conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics 4.
• A trial of topical antibiotic ointment and/or ocular lubricants can be effective in treating epiblepharon, a condition that can cause eyelid infection, and most patients resolve with minimal symptoms 5.
• For meibomian gland dysfunction, a condition that can cause eyelid infection, treatments such as thermal pulsation, intense pulsed light therapy, and meibomian gland probing can be effective, although the extent of improvement and persistency of outcomes varied between the different treatments 6.

Conservative Management

• Conservative management of eyelid infections, such as conjunctivitis, can include educating patients on the self-limiting nature of the condition and providing written information materials to increase compliance with conservative treatment 3.
• A trial of conservative treatment, including topical antibiotic ointment and/or ocular lubricants, can be effective in treating epiblepharon and meibomian gland dysfunction before considering surgical intervention 5, 6.

Antibiotic Use

• Antibiotics should be prescribed judiciously, as overuse can lead to delayed diagnosis of other serious red eye conditions and contribute to antibiotic resistance 3, 4.
• Topical antibiotics can be effective in treating bacterial conjunctivitis, but should only be used when necessary and in accordance with clinical guidelines 4.