Blepharitis

- Inflammation of the eyelids associated with irritation, hyperemia, foreign body sensation, and crusting of eyelids.

- Anterior blepharitis - inflammation of the lash margin caused by bacterial infection:  S. aureus, S. epidermidis, Cutibacterium acnes, Corynebacterium spp, or associated with seborrhea (burning, scaling, itching but less inflammation).

- Other infectious conditions associated with eyelid inflammation:

 

Bacterial:

  • Impetigo (S. aureus)
  • Erysipelas (S. pyogenes)
  • Angular blepharitis (Moraxella spp)

Viral:

  • Herpes simplex
  • Molluscum contagiosum
  • Papilloma virus

Parasitic:

  • Pthirus pubis – acute presentation
  • Demodex folliculorum- chronic presentation

- Posterior blepharitis- inflammation of the Meibomian glands (meibomitis) caused by meibomian gland dysfunction, infection, allergy, systemic conditions (rosacea/eczema/atopy)

 

Management:

  • Lid hygiene - twice daily for at least 6 weeks:
    • Eyelid cleansing with baby shampoo (anterior blepharitis)
    • Warm compresses (especially for posterior blepharitis)
    • Lid margin massage (especially for posterior blepharitis)
    • Lash scrubs
  • Failure of persistent lid hygiene:

Note: The role of topical antibiotics +/- topical steroids remains somewhat controversial but may improve symptoms.

Anterior blepharitis

Empiric Therapy Dose Duration
Lid hygiene (see Management above)  
+    
Ophthalmic Ointments:    
Erythromycin 0.5% 1–4 times per day for 1–2 wks. If effective, treatment can be reduced to once daily at bedtime for a further 4–8 wks 2-8 weeks
+/-    
Dexamethasone 0.1% tid-qid Taper as soon as inflammation decreases
Alternative for acute exacerbations:  
Antibacterial/Corticosteroid Combinations:  

Tobramycin 0.3%/

dexamethasone 0.1%

tid-qid For short-term use for acute exacerbations
or    

Neomycin/polymyxin B/

dexamethasone 0.1%

tid-qid For short-term use for acute exacerbations

 

Posterior blepharitis

Empiric Therapy Dose Duration
Lid hygiene (see Management above)
 
+    
Oral antibiotics for secondary hordeola:  
Doxycycline 100mg PO daily 3 weeks
or    
Azithromycin

1 g PO weekly or

500 mg PO daily for 3 days of each week

3 weeks

 

Pthirus pubis

  • manual removal with forceps
  • petroleum jelly
  • treatment of linens/personal items

Demodex

Empiric Therapy Dose Duration
Ivermectin 200mcg/kg PO weekly 2 weeks
or    
Tea tree oil

Use ophthalmic foam cleanser or medicated pad once daily as directed by optometrist or ophthalmologist

 

 

If no improvement or if any visual disturbances, refer to optometrist or ophthalmologist.