Blepharitis - Treatment and Management

Treatment and Management

The single most important treatment principle is a daily routine of lid margin hygiene, as described below. Such a routine needs to be convenient enough to be continued for life to avoid relapses as blepharitis is often a chronic condition. But it can be acute, and one episode does not mean it is a lifelong condition.

A typical lid margin hygiene routine consists of four steps:

1. Softening of lid margin debris and oils: Apply a warm wet compress to the lids - such as a washcloth with hot water - for about two minutes. New, dry, warm compress masks can be conveniently warmed in a micro-wave oven and maintain a comfortable 40C temperature for 10 minutes while the waxy oils blocking the glands are cleared. The humidity created also helps to reduce the evaporation of natural tears which are important in soothing the cornea.
2. Mechanical removal of lid margin debris: At the end of a shower routine, wash your face with a wash cloth. Use facial soap or non-burning baby shampoo (make sure to dilute the soap solution 1/10 with water first). Gently and repeatedly rub along the lid margins while eyes are closed. Too much soap or shampoo may remove the essential oily layer of the eyes' own tear film and create further problems with dry eye discomfort.
3. Antibiotic reduction of lid margin bacteria (at the discretion of a physician): After lid margin cleaning, spread small amount of prescription antibiotic ophthalmic ointment with finger tip along lid fissure while eyes closed. Use prior to bed time as opposed to in the morning to avoid blurry vision.
4. Avoid the use of eye make-up until symptoms subside.

The following guide is very common but is more challenging to perform by visually disabled or frail patients as it requires good motor skills and a mirror. Compared with the above, it does not bear any advantages:

1. Apply hot compresses to both eyes for five minutes once to twice per day. The "hot wet flannel" treatment is often recommended, however this does not stay hot for long enough, is very messy & potentially unhygienic. A very effective alternative is a flax filled mask which is heated in a microwave oven.
2. After hot compresses, in front of a mirror, use a moist cotton bud soaked in a cup of water with a drop of baby shampoo, or a drop of antibiotic such as Chloramphenicol. Rub along the lid margins while tilting the lid outward with the other hand.
3. In front of mirror, place small drop of antibiotic ophthalmic ointment (e.g. erythromycin) in lower conjunctival sac while pulling lid away from eye with other hand.

Often the above is advised together with mild massage to mechanically empty glands located at the lid margin (Meibomian glands, Zeis glands, Moll glands).

Dermatologists treat blepharitis similarly to seborrhoeic dermatitis by using a safe topical anti-inflammatory medication like sulfacetamide or brief courses of a mild topical steroid. Although anti-fungals like ketoconazole (Nizoral) are commonly prescribed for seborrhoeic dermatitis, dermatologists and optometrists usually do not prescribe anti-fungals for seborrhoeic blepharitis.

If these conventional treatments for blepharitis do not bring relief, patients may consider allergy testing and ocular antihistamines. Allergic responses to dust mite feces and other allergens can cause lid inflammation, ocular irritation, and dry eyes. Prescription ocular antihistamines and over-the-counter ocular antihistamines are very safe and can bring almost immediate relief to patients whose lid inflammation is caused by allergies.

Small studies have shown N-acetylcysteine supplementation to be of benefit to sufferers of blepharitis.

Researchers have found Omega-3 supplementation in the form of Fish Oil or Flaxseed to be beneficial in reducing the primary symptoms of Blepharitis.