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Blepharitis - Management
How should I treat a person with blepharitis on the first presentation?
- Advise the person that good eyelid hygiene is the mainstay of treatment and should be carried out twice daily initially, then reduced to once daily. The eyelids should be cleaned in a stepwise manner:
- Apply warm compresses to the closed eyelids for 5–10 minutes.
- For posterior blepharitis, massage the eyelid to express Meibomian glands.
- Clean the eyelid — wet a cloth or cotton bud with cleanser (e.g. baby shampoo diluted with warm water) and rub along the lid margins.
- Avoid eye make-up, especially eyeliner. If this is not possible, use an eyeliner that washes off easily.
- Blepharitis frequently causes dry eye. Prescribe artificial tears or an ocular lubricant to relieve symptoms (for more information, see the CKS topic on Dry eye syndrome).
- Consider prescribing topical antibiotics (chloramphenicol or fusidic acid) or oral antibiotics (tetracyclines) if there are clear signs of staphylococcal infection or Meibomian gland dysfunction, respectively. Antibiotics should usually be reserved for second-line use when eyelid hygiene alone has proved ineffective — see Second-line treatment.
In depth
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