Blepharitis is a common cause of eyelid and ocular surface discomfort in patients who are unresponsive to dry eye treatments. Dry eye is often worse later in the day while blepharitis causes more morning discomfort, irritation, and eye redness. The most common cause is a dysfucttion of the meibomian glands, or posterior eyelid margin. When the meibomian glands are dysfunctional, the tear film stability is decreased and tear evaporation is increased, causing ocular discomfort.
Treatment for Blepharitis
Lid Hygiene
Warm compresses twice daily for 5 minutes can have a beneficial effect in opening the plugged oily glands of fthe eyelid margin, stabilizing the tear film. Eye lid massage after the hot compresses is also beneficial and can be done with a sudsy washcloth with baby shampoo.
Topical antibiotic ointment
Bacitracin or erythromycin courses of topical antibiotic ointment can benefit at bedtime if there is an anterior blepharitis component associated with the condition. Bacitracin has better staph coverage than erythromycin.
Additional Treatment
Oral doxycycline
As an adjunct to control but not cure the disease, blepharitis can be treated with oral doxycycline of 100-200 mg daily for a one to two month course. Often 3-4 weeks of treatment is required before a significant improvement is appreciated by the patient. Oral doxycycline is contraindicated in children under 8 years old, pregnancy, and needs physician clearance in the presence of liver disease, coumadin, birth control pills, and methotrexate.
Other treatments of
Topical Steroids
Topical steroids can be used short-term, with a mid or low-strength concentration (loteprednol 0.2-0.5%), but should be avoided long term with high strength. Topical Restatis (cyclosporine A 0.1%).
Systemic Omega-3 Fatty Acid Supplements
Omega-3 supplements, flax seed or fish oil supplements, can also improve dry eye and may benefit eyelid disease of blepharitis.
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