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Blepharitis - Management
Overview of management

  • Assess the severity and impact of blepharitis, previous treatments and response, type of blepharitis, presence of associated conditions, and the presence of complications.
  • Provide information about the course of the disorder and emphasize the importance of complying with treatment, especially eyelid hygiene.
  • Treat according to the type of blepharitis (if known) and the severity of the condition.
    • Eyelid hygiene is the mainstay of treatment regardless of the cause and needs to be continued indefinitely.
    • Blepharitis is commonly associated with dry eyes. Consider symptomatic treatment with artificial tears and ocular lubricants (see the CKS topic on Dry eye syndrome).
    • Topical or oral antibiotics may occasionally be needed at initial presentation.
  • If initial treatment is inadequate, consider prescribing an antibiotic second-line:
    • Use topical chloramphenicol ointment if staphylococcal infection is considered to be a factor in poor response. Topical fusidic acid is an alternative.
    • Use an oral tetracycline (tetracycline, oxytetracycline, lymecycline, or doxycycline) if Meibomian gland dysfunction is suspected.
  • Refer if the condition fails to improve after maximal treatment in primary care, or if the person has:
    • Sudden onset of visual loss, or an eye becomes acutely painful and red — provide same-day referral.
    • Signs and symptoms consistent with cancer.
    • Gradually deteriorating vision or other evidence of corneal disease.
    • Associated disease that needs treatment (e.g. Sjögren's syndrome or eyelid deformities).
    • Uncertain diagnosis.

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