What are the steps in eyelid hygiene for the treatment of adult blepharitis?

Updated: Jan 03, 2019
  • Author: R Scott Lowery, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Many appropriate systems of eyelid hygiene exist, and all include variations of 3 essential steps, as follows:

  • First, application of heat to warm the eyelid gland secretions, to bring the turbid lipid glandular material to its melting point and resultant liquification, and to promote evacuation and cleansing of the secretory passages is essential. Patients commonly are directed to use soaked warm compresses and to apply them to the lids repeatedly. Warm water in a washcloth, soaked gauze pads, or microwaved, soaked cloths can be used. Many useful eyelid applicators are readily available and provide a more sterile application surface. Patients should be instructed to use care to avoid the use of excessive heat.
  • Second, the eyelid margin is washed mechanically to remove adherent material, such as scurf, collarettes, and crusting, and to clean the gland orifices. This can be completed with a warm washcloth or with cotton-tip applicators or gauze pads. Tap water is often mistakenly used, rather than normal saline or boiled distilled water. Many clinicians instruct patients to mix a few drops of baby shampoo with warm water to form a cleaning solution. Several useful commercially available cleansing preparations are also available, including Ocusoft (generic), lavender scrubs (Oasis), and hypochlorous acid (Avenova). Attention must be directed to gentle mechanical jostling or scrubbing of the eyelid margin itself, not the skin of the lids or of the bulbar conjunctival surface. Vigorous scrubbing is not necessary and may be harmful.
  • Third, an antibiotic ointment is applied to the eyelid margin after it has been soaked and scrubbed. Commonly used agents include bacitracin, polymyxin B, erythromycin, or sulfacetamide ointments. Antibiotic-corticosteroid ointment combinations can be used for short courses, although, because of the risks associated with ocular steroids, their use is less appropriate for long-term management.

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