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

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 ¹. They should then gently wipe along the lid margins to clear any debris ¹. This should be done twice daily initially, and then once daily as symptoms improve ¹. Eyelid hygiene is considered the mainstay of blepharitis treatment ¹.
• 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 ¹. It is important to ensure the compress is not too hot to avoid burning the skin ¹. Warm compresses can be particularly helpful for posterior blepharitis and meibomian gland dysfunction ¹.
• 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 ¹. 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 ¹. Patients with glaucoma should avoid putting pressure on their lids, as this may increase eye pressure ¹.
• Ongoing Treatment: It is crucial to explain the chronic nature of blepharitis and the need for ongoing treatment ¹. Patients should continue conservative treatment, especially eyelid hygiene, even when symptoms are well controlled, to minimise the number and severity of relapses ¹.
• Avoid Cosmetics: Advise patients to avoid eye makeup, particularly eyeliner and mascara, during exacerbations of blepharitis ¹.
• 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 ¹.