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Blepharitis - Management
Which artificial tear or ocular lubricant should I prescribe?

  • The severity of the condition and the person's preference should guide the choice of artificial tears and ocular lubricants:
    • Mild or moderate symptoms — artificial tears alone are usually sufficient:
      • Hypromellose is the most commonly used product, but it requires frequent administration (at 30-minute intervals until symptoms improve, then frequency can be decreased).
      • Products containing carbomers or polyvinyl chloride are longer acting.
      • Sodium chloride is short acting and suitable as 'comfort drops' or for use with contact lenses.
      • If a product is used very frequently (e.g. more than six applications daily) or causes irritation, or if soft contact lenses are worn, consider switching to one that is preservative free, as these cause less irritation. Hypromellose, carbomers, polyvinyl chloride, sodium chloride, carmellose sodium, hydroxyethylcellulose, and povidone are available without preservatives.
    • Severe symptoms — preservative-free artificial tears are suitable (to avoid irritation caused by preservatives). Consider adding an ocular lubricant ointment for use at night.
    • Visible strands of mucus — consider prescribing acetylcysteine drops.
  • For further information on the management of dry eye syndrome, including use of conservative (self-care) measures, and for the rationale for using artificial tears and ocular lubricants, see the CKS topic on Dry eye syndrome.

[Khaw et al, 2004; American Academy of Ophthalmology, 2006; BNF 54, 2007; DEWS, 2007]

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