Blepharitis medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 6: Line 6:


==Medical Therapy==
==Medical Therapy==
 
===Antimicrobial Regimens===
::*'''1. Empiric antimicrobial therapy'''<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref>
*'''1. Empiric antimicrobial therapy'''<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref>
:::*'''Blepharitis'''
:*'''Blepharitis'''
::::*Preferred regimen: [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days
::*Preferred regimen: [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days
::::*Alternative regimen (1): [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks
::*Alternative regimen (1): [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks
::::*Alternative regimen (2): [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks
::*Alternative regimen (2): [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks
::::*Alternative regimen (3): [[Erythromycin]]ophthalmic ointment qhs for 2 weeks
::*Alternative regimen (3): [[Erythromycin]]ophthalmic ointment qhs for 2 weeks
::::*Alternative regimen (4): [[Metronidazole]] 2% gel bid for 1-2 weeks
::*Alternative regimen (4): [[Metronidazole]] 2% gel bid for 1-2 weeks
::::*Note: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months may be helpful in some cases of posterior blepharitis
::*Note: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months may be helpful in some cases of posterior blepharitis
::*'''2. Specific considerations'''
*'''2. Specific considerations'''
:::*'''2.1 Meibomian gland dysfunction''':
:*'''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.
::*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
::*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
::*Note: [[Tetracyclines]] are contraindicated among pregnant women, nursing women, and young children < 8 years of age
:::*'''2.2 Dry eye'''
:*'''2.2 Dry eye'''
::::*Preferred regimen: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months
::*Preferred regimen: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months
:::*'''2.3 Ocular Rosacea'''
:*'''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)
::*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. Pathogen-directed antimicrobial therapy'''
:::*'''3.1 Staphylococcus spp.'''
:*'''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
::*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'''
:*'''3.2 Demodex folliculorum'''
::::*Preferred regimen: [[Metronidazole]] 2% gel bid for 1-2 weeks
::*Preferred regimen: [[Metronidazole]] 2% gel bid for 1-2 weeks
::::*Alternative regimen: [[Ivermectin]] 200 microgram/kg once weekly for 2 weeks
::*Alternative regimen: [[Ivermectin]] 200 microgram/kg once weekly for 2 weeks


==References==
==References==

Revision as of 16:36, 27 August 2015

Blepharitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Blepharitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Blepharitis medical therapy On the Web

recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Blepharitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

National Guidelines Clearinghouse

NICE Guidance

FDA on Blepharitis medical therapy

CDC on Blepharitis medical therapy

Blepharitis medical therapy in the news

Blogs on Blepharitis medical therapy

Directions to Hospitals Treating Blepharitis

Risk calculators and risk factors for Blepharitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topic therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.

Medical Therapy

Antimicrobial Regimens

  • 1. Empiric antimicrobial therapy[1]
  • 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.
  • 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. ↑ "Blepharitis PPP 2013".

[[Category:Needs overview Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Blepharitis_medical_therapy&oldid=1146360"