How is blepharitis treated?

Updated: Jul 31, 2018
  • Author: Bobak Zonnoor , MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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The treatment of blepharitis, regardless of etiology, begins with eyelid hygiene. The patient should be instructed to wash the lids with a nonirritating baby shampoo or a commercially prepared lid scrubbing solution and to use warm compresses for 15 minutes at a time, 3 or 4 times a day. Collarettes at the base of the lashes can be gently removed using a cotton-tipped applicator.

If the blepharitis is suspected of being infectious, a topical antibiotic such as bacitracin, erythromycin, [71] or levofloxacin [72] should be prescribed. The frequency and duration of treatment should be determined based on the severity of the disease process. [73] Usually, the topical antibiotic is applied 2-4 times daily for 2 weeks. [74]

Posterior blepharitis may be treated with an oral tetracycline; this medication decreases lipase production in staphylococci, preventing plugging of Meibomian glands. Such therapy is limited to patients older than 8 years due to the risk of tooth enamel discoloration. [73] Alternative treatment with topical azithromycin is effective and safe. [75]

Other medications used to treat blepharitis include the following [76] :

  • Sodium fusidate - This agent, containing fusidic acid, is effective against most microbial species responsible for blepharitis, including methicillin-resistant S aureus [27, 77]

  • Topical cyclosporine - This showed benefit in the treatment of posterior blepharitis in a small study of 30 patients, compared with treatment with tobramycin/dexamethasone [23]

  • Botulinum toxin A injection - Such therapy has been shown to be beneficial in the treatment of chalazia [78]

  • Steroids - A brief course of preservative-free, topical steroids has been shown to decrease ocular surface inflammation; its use is reserved for cases with severe inflammation.

If blepharitis is caused by infestation with the mite D folliculorum, treatment with weekly lid scrubs with 50% tea tree oil and daily scrubs with tea tree shampoo for a minimum of 6 weeks has been shown to decrease mite load and improve inflammatory responses. [79]

Phthiriasis palpebrarum has been treated with twice-daily application of petrolatum for 7-10 days. This therapy fails to kill ova, however, and infection may be persistent. An alternative therapy has been proposed using pilocarpine 4% gel twice daily for 10 days. The mechanism of action of this therapy is not well understood. [80] In addition, removal of the nits and lice can be accomplished with forceps.

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