Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
The recommended first-line treatments for managing blepharitis in adults primarily focus on conservative measures and managing associated conditions NICE CKS.
- Eyelid Hygiene and Warm Compresses: Eyelid hygiene is considered the mainstay of treatment NICE CKS. 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 NICE CKS. This should be done twice daily initially, then once daily as symptoms improve NICE CKS. 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 NICE CKS. 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 NICE CKS. 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 NICE CKS. They should also avoid eye makeup, particularly eyeliner and mascara, during exacerbations NICE CKS.
- 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 NICE CKS.
- Topical Antibiotics: If eyelid measures are ineffective for anterior blepharitis, a topical antibiotic such as chloramphenicol can be considered NICE CKS. This can be rubbed into the lid margin, typically twice daily NICE CKS. Treatment duration is usually a few weeks until acute symptoms resolve NICE CKS.