What advice should I provide to patients regarding eyelid hygiene to prevent recurrence of blepharitis?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

To prevent the recurrence of blepharitis, patients should be advised on consistent eyelid hygiene practices:

  • Eyelid Cleansing: Patients should wet a clean cloth or cotton bud with a suitable cleanser, such as baby shampoo diluted 1:10 with warm water, a solution of sodium bicarbonate in warm water, or a manufactured lid cleansing product . They should then gently wipe along the lid margins to clear any debris . This should be done twice daily initially, and then once daily as symptoms improve . Eyelid hygiene is considered the mainstay of blepharitis treatment .
  • Warm Compresses: Advise patients to apply a warm compress, such as a clean flannel rinsed with warm water, to their closed eyelids for 5–10 minutes once or twice daily . It is important to ensure the compress is not too hot to avoid burning the skin . Warm compresses can be particularly helpful for posterior blepharitis and meibomian gland dysfunction .
  • Eyelid Massage: For patients with posterior blepharitis, after applying a warm compress, they can gently massage the eyelid area using clean fingers or a cotton bud . The massage should be in the direction of the eyelashes (downward movement on the upper lid and upward movement on the lower lid) to help express meibomian gland content . Patients with glaucoma should avoid putting pressure on their lids, as this may increase eye pressure .
  • Ongoing Treatment: It is crucial to explain the chronic nature of blepharitis and the need for ongoing treatment . Patients should continue conservative treatment, especially eyelid hygiene, even when symptoms are well controlled, to minimise the number and severity of relapses .
  • Avoid Cosmetics: Advise patients to avoid eye makeup, particularly eyeliner and mascara, during exacerbations of blepharitis .
  • Manage Associated Conditions: Patients should be encouraged to treat any associated conditions, such as dry eye disease, seborrhoeic dermatitis, or rosacea, as this is essential for successful blepharitis management .

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