Management

Blepharitis is typically a chronic condition that cannot be permanently cured but long-term management of symptoms can address both infectious and inflammatory components of the disease (1,2).

Non pharmacological management:

• lid hygiene is the first line of treatment regardless of type of blepharitis (3) – due to the chronic nature of the condition patients should continue eye lid hygiene even after improvement
  • apply warm compress on eyelids for 5–10 minute intervals
    • helps in expression of meibomian gland secretions and to loosen collarettes and crusts
  • use of eyelid scrubs (diluted baby shampoo, sodium bicarbonate solution or dedicated lid cleaning solution with a swab or cotton bud):
    • to wipe away bacteria and deposits from lid margins and mechanically expresses the lid glands
    • done twice daily at first, then reduce to once daily as condition improves
    • firm pressure should be applied with swab or cotton bud so as to express glands
  • eyelid massage – pressing the eyelid against the eyeball will aid in expressing Meibomian glands, more useful in posterior lid disease or MGD (1,4)
• avoidance of cosmetics – especially eye liner and mascara
• seborrhoeic dermatitis and dandruff should be treated (4)
• mechanical irritation due to over vigorous scrubbing or sensitivity reaction to detergents may be a few adverse effects of this management method (1)

Pharmacological management:

• antibiotics - should be considered when an infection is present and after lid hygiene manoeuvres.:
  • topical antibiotic e.g. fusidic acid eye drops, applied twice daily after lid hygiene (the lid margins are cleaned once or twice a day with a cotton bud moistened with lukewarm, previously boiled, water) (1)
    • some may require long-term therapy to remain symptom free (1)
      • if chronic blepharitis, then long-term treatment will generally be required
        • if chronic blepharitis then consult expert advice
        • may require oral tetracycline +/- topical antibiotics
          
  • oral tetracycline e.g. oxytetracycline, doxycycline or minocycline
    • used when lid hygiene and topical antibiotic fails
    • in patients with MGD or rosacea
    • used for several weeks and tapered after clinical improvement is noted
    • contraindicated in pregnant or lactating women or children younger than 12 years – use oral erythromycin or azithromycin (4)
      
  • topical azithromycin (5) has been used
    • proposed as novel treatment for posterior blepharitis due to its antibacterial and anti-inflammatory properties
      
  • anti-Demodex therapy – should be managed by ophthalmologists and experienced practitioners (3)
    
• low-dose topical corticosteroids
  • seek expert advice
    • a short course during an acute exacerbation (typically a drop several times a day) tapered to discontinuation over one to three weeks can sometimes be prescribed (1).

Reference:

• (1) Lindsley K et al. Interventions for chronic blepharitis. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD005556. DOI: 10.1002/14651858.CD005556.pub2. Accessed 11 March 2022.
• (2) Pflugfelder SC, Karpecki PM, Perez VL. Treatment of blepharitis: recent clinical trials. Ocul Surf. 2014 Oct;12(4):273-84. doi: 10.1016/j.jtos.2014.05.005.
• (3) The College of Optometrists (2021). Blepharitis (Lid Margin Disease).
• (4) Amescua G et al; American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Blepharitis Preferred Practice Pattern®. Ophthalmology. 2019 Jan;126(1):P56-P93. doi: 10.1016/j.ophtha.2018.10.019.
• (5) Luchs J. Azithromycin in DuraSite for the treatment of blepharitis. Clin Ophthalmol. 2010;4:681-8