Blepharitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
The single most important treatment principle is a daily routine of lid margin hygiene as described below. Such a routine needs to be convenient enough to be continued lifelong to avoid relapses as blepharitis is a lifelong condition.
A typical lid margin hygiene routine consists of 3 steps:
1. Softening of lid margin debris and oils:
Apply a warm wet compress to the lids - such as a washcloth with hot water - for about 2 minutes.
2. Mechanical removal of lid margin debris:
At end of shower routine, wash your face with a wash cloth. Use facial soap or non-burning baby shampoo (make sure to dilute the soap solution 1/10 with water first). Gently and repeatedly rub along the lid margins while eyes are closed.
3. Antibiotic reduction of lid margin bacteria (at the discretion of your physician):
After lid margin cleaning, spread small amount of prescription antibiotic ophthalmic ointment with finger tip along lid fissure while eyes closed. Use prior to bed time as opposed to in the morning to avoid blurry vision.
The following guide is very common but is more challenging to perform by visually disabled or frail patients as it requires good motor skills and a mirror. Compared to above it does not bear any advantages:
1. Apply hot compresses to both eyes for 5 minutes once to twice per day.
2. After hot compresses, in front of a mirror, use a moist Q-tip soaked in a cup of water with a drop of baby shampoo. Rub along the lid margins while tilting the lid outward with the other hand.
3. In front of mirror, place small drop of antibiotic ophthalmic ointment (e.g. erythromycin) in lower conjunctival sack while pulling lid away from eye with other hand.
Often the above is advised together with mild massage to mechanically empty glands located at the lid margin (Meibomian glands, Zeiss glands, Moll glands). [1]
Depending on the degree of inflammation of the lid margin, a combination of topical antibiotic and steroid drops or ointments can be prescribed to provide instant relief. However, this harbors significant risks such as increased intraocular pressure and posterior subcapsular cataract formation. Since cataract formation is irreversible and even intraocular hypertension might be (harboring the risk of glaucoma with permanent visual loss), both need to be checked for monthly. Steroid-induced cataracts and ocular hypertension can affect all ages.
If acne rosacea coexists, treatment should be focused on this skin disorder as the underlying cause together with the above lid margin hygiene routine. Typically, 100 mg doxycycline by mouth twice per day is prescribed for four to six weeks which can be tapered to 50 mg once daily for several years. Some physicians use a lower starting dose. Patients are instructed to continue use for at least two months before symptoms improve significantly. Contrary to common belief, use of tetracycline-type antibiotics is not primarily to treat bacterial infection but rather to inhibit matrix metalloproteinases resulting in thinning of oil gland secretions and change of the characteristic prominent capillary pattern.
Dermatologists treat blepharitis similarly to seborrheic dermatitis by using safe topical anti-inflammatory medication likesulfacetamide or brief courses of a mild topical steroid. Although anti-fungals like ketoconazole (Nizoral) are commonly prescribed for seborrheic dermatitis, dermatologists and optometrists usually do not prescribe anti-fungals for seborrheic blepharitis. [2]
4. Ocular Antihistamines and allergy treatments:
If these conventional treatments for blepharitis do not bring relief, patients should consider allergy testing. Allergic responses to dust mite feces and other allergens can cause lid inflammation, ocular irritation, and dry eyes. Prescription optical antihistamines like Patanol, Optivar, Elestat, and over the counter optical antihistamines like Zaditor are very safe and can bring almost immediate relief to patients whose lid inflammation is caused by allergies.
References
- ↑ Moorfields eye hospital (UK) Patient information leaflet: Blepharitis - Lid Hygiene Advice For Patients
- ↑ Derbel M, Benzina Z, Ghorbel I, Abdelmoula S, Makni F, Ayadi A, Feki J (2005). "[Malassezia fungal blepharitis: a case report]". J Fr Ophtalmol. 28 (8): 862–5. PMID 16249768.
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