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]

Medical Therapy

• 1. Empiric antimicrobial therapy

• Blepharitis

• 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 (2): Bacitracin ophthalmic ointment qhs for 2 weeks OR Bacitracin/Polymyxin B Sulfate ophthalmic ointment bid to qid for 2 weeks
• Alternative regimen (3): Erythromycinophthalmic ointment qhs for 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

• 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 Erythromycinophthalmic 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

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