Blepharitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2], Sara Mehrsefat, M.D. [3]
Overview
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.[1]
Medical Therapy
General Management
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. As blepharitis is a chronic disease, eyelid hygiene and regular cleaning must be performed even after an acute exacerbation has resolved. General management of blepharitis includes:[1][2][3]
- Warm compresses: heat can liquefy the abnormal solidified meibomian secretions and increase the quantity of secretions.
- Eyelid cleansing: gentle washing of the lashes and eyelid margins with warm water, eyelid scrub solutions, or baby shampoo to remove the accumulated material.
- Eyelid massage: massage may help empty the meibomian glands and improve secretion.
- Antibiotics (topical and/or systemic): antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause. It is important to consider eyelid margin hygiene before applying the topical therapy.
- Topical anti-inflammatory agents (e.g., corticosteroids, cyclosporine)
Antimicrobial Regimens
- Blepharitis[4]
- 1. Empiric antimicrobial therapy
- Preferred regimen (1): Bacitracin topical one or more times daily or at bedtime for a few weeks
- Preferred regimen (2): Erythromycin topical one or more times daily or at bedtime for a few weeks
- Alternative regimen (1): Metronidazole topical (for cases unresponsive to Bacitracin or Erythromycin)
- Alternative regimen (2): Tobramycin/Dexamethasone ophthalmic suspension
- Alternative regimen (3): Azithromycin sustained release
- Note (1): Cure is usually not possible with blepharitis. Eyelid hygiene may provide symptomatic relief for both anterior and posterior blepharitis.
- Note (2): Cyclosporine topical drops 0.05% may be helpful in some patients with posterior blepharitis.
- 2. Specific considerations
- 2.1 Meibomian gland dysfunction
- Preferred regimen: Doxycycline 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks OR Minocycline 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks OR Tetracycline 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks.
- Alternative regimen (1): Erythromycin 250-500 mg PO qd for 3 weeks OR Azithromycin 250-500 mg PO 1-3 times a week for 3 weeks OR Azithromycin 1 g PO once per week for 3 weeks
- Note: Tetracyclines are contraindicated among pregnant women, nursing women, and young children < 8 years of age
- 2.2 Dry eye
- Preferred regimen: Cyclosporine 0.05% ophthalmic emulsion bid for 6 months
- 2.3 Ocular rosacea
- Preferred regimen: Doxycycline 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks OR Minocycline 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks OR Tetracycline 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks OR (Azithromycin 250-500 mg PO 1-3 times a week for 3 weeks AND Tacrolimus 0.1% topical bid for 3 weeks) OR (Azithromycin 1 g PO once per week for 3 weeks AND Tacrolimus 0.1% topical bid for 3 weeks)
- 3. Pathogen-directed antimicrobial therapy
- 3.1 Staphylococcus spp.
- Preferred regimen: Bacitracin ophthalmic ointment qhs for 2 weeks OR Bacitracin/Polymyxin B Sulfate ophthalmic ointment bid to qid for 2 weeks OR Erythromycin ophthalmic ointment qhs for 2 weeks OR Azithromycin 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days OR Tobramycin/Dexamethasone 0.3%/0.05% ophthalmic suspension qid for 2 weeks
- 3.2 Demodex folliculorum
- Preferred regimen: Metronidazole 2% gel bid for 1-2 weeks
- Alternative regimen: Ivermectin 200 microgram/kg once weekly for 2 weeks
References
- ↑ 1.0 1.1 Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T; et al. (2011). "The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction". Invest Ophthalmol Vis Sci. 52 (4): 2050–64. doi:10.1167/iovs.10-6997g. PMC 3072163. PMID 21450919.
- ↑ Arita R, Morishige N, Shirakawa R, Sato Y, Amano S (2015). "Effects of Eyelid Warming Devices on Tear Film Parameters in Normal Subjects and Patients with Meibomian Gland Dysfunction". Ocul Surf. 13 (4): 321–30. doi:10.1016/j.jtos.2015.04.005. PMID 26031204.
- ↑ Benitez-Del-Castillo JM (2012). "How to promote and preserve eyelid health". Clin Ophthalmol. 6: 1689–98. doi:10.2147/OPTH.S33133. PMC 3484726. PMID 23118519.
- ↑ "Blepharitis PPP 2013".