What are the recommended first-line treatments for managing blepharitis in adults?

The recommended first-line treatments for managing blepharitis in adults primarily focus on conservative measures and managing associated conditions ¹.

• Eyelid Hygiene and Warm Compresses: Eyelid hygiene is considered the mainstay of treatment ¹. Patients should be advised to wet a cloth or cotton bud with a cleanser (e.g., baby shampoo diluted 1:10 with warm water, sodium bicarbonate solution, or manufactured lid cleansing products) and gently wipe along the lid margins to clear debris ¹. This should be done twice daily initially, then once daily as symptoms improve ¹. A warm compress, such as a clean flannel rinsed with warm water, should be applied to closed eyelids for 5–10 minutes once or twice daily ¹. For posterior blepharitis, eyelid massage can be performed after applying the warm compress, gently massaging the area in the direction of the eyelashes to express meibomian gland content ¹. Patients should be educated on the chronic nature of blepharitis and the importance of continuing conservative treatment, especially eyelid hygiene, even when symptoms are well controlled, to minimise relapses ¹. They should also avoid eye makeup, particularly eyeliner and mascara, during exacerbations ¹.
• Managing Associated Conditions: Treatment of any associated or underlying medical conditions, such as dry eye disease, seborrhoeic dermatitis, or rosacea, is essential for successful management ¹.
• Topical Antibiotics: If eyelid measures are ineffective for anterior blepharitis, a topical antibiotic such as chloramphenicol can be considered ¹. This can be rubbed into the lid margin, typically twice daily ¹. Treatment duration is usually a few weeks until acute symptoms resolve ¹.