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.