When should I consider referring a patient with blepharitis to an ophthalmologist?

Consider referring a patient with blepharitis to an ophthalmologist in the following situations:

• If there are symptoms of corneal disease such as pain and blurred vision, or if there is rapid-onset visual loss, or if the eye becomes painful and/or red, arrange same-day ophthalmological assessment.
• If there is gradual deterioration of vision or if the diagnosis is uncertain.
• If primary care treatment is ineffective, especially in posterior blepharitis associated with meibomian gland dysfunction and rosacea, consider referral with urgency depending on the clinical situation.
• Have a low threshold for referring children with blepharitis.
• If there are signs or symptoms of periorbital or orbital cellulitis, arrange emergency hospital admission or same-day referral to ophthalmology or emergency department.
• If a malignant eyelid cancer is suspected, refer urgently using a suspected cancer pathway.

In all other cases, initial management with eyelid hygiene, warm compresses, and topical antibiotics (for anterior blepharitis) is recommended, with referral considered if symptoms persist, worsen, or new features develop.

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