eyes.nhs.scot

• 1.1 Basal Cell Carcinoma, Periocular
• 1.2 Blepharitis, Anterior
• 1.3 Blepharitis, Posterior
• 1.4 Chalazion (Meibomian Cyst)
• 1.5 Dermatochalasis
• 1.6 Ectropion
• 1.7 Entropion
• 1.8 Facial Palsy (Bell's Palsy)
• 1.9 Hordeolum (Stye)
• 1.10 Horner’s Syndrome (Oculosympathetic Palsy)
• 1.11 Molluscum Contagiosum
• 1.12 Ocular Rosacea
• 1.13 Penetrating Injury, Eyelid
• 1.14 Phthiriasis (Pediculosis Ciliaris/Crabs)
• 1.15 Ptosis, Involutional
• 1.16 Third Nerve Palsy, Ptosis
• 1.17 Trichiasis

Date of last review: Due to be updated

Differential diagnosis

• Tear deficiency
• Interstitial keratitis
• Infectious keratitis
• Other causes of chronic blepharitis

Possible management by Optometrist

Treatment

• Ocular lubricants for tear deficiency/instability related symptoms (drops for use during the day, unmedicated ointment for use at bedtime)
• Treat associated posterior blepharitis
• PoM Antibiotics require co-management with GP- tetracyclines contra-indicated in children, pregnant women, breast-feeding women
• PoM Topical Metronidazole 0.75% gel (adults over 18 years) applied thinly twice daily to face and eyelids for 6 to 9 weeks, then intermittently
• Review at 6 to 9 weeks
• If effective options, depending on patient preference, are:
• Stop treatment and review regularly
• Tail treatment off
• Reduce frequency to alternate days, then twice weekly
• Long term intermittent maintenance may be required
• If ineffective consider oral antibiotic
• PoM Doxcycline (adults over 18 years) 100mg once daily for up to 3 months, repeated courses may be necessary
• Or PoM Erythromycin (adults over 18 years), if tetracyclines contraindicated, 500mg twice a day for up to 3 months; repeated courses may be necessary
• Review at 3 months
• If effective options, depending on patient preference, are
• Stop treatment and review regularly
• Tail treatment off then stop
• Halve dose for 2-6 months
• Long term intermittent maintenance may be required
• Switch to Topical Metronidazole 0.75% gel

Advice

• Explain rosacea is an idiopathic long-term skin condition, which comes and goes
• It causes inflammation of the skin of the face and the eyelids, particularly cheeks, forehead and chin
• Swelling of the nose (rhinophymoma), a complication that patients often fear, is uncommon, especially in women, and treatable
• Rosacea is not caused by poor hygiene or excess alcohol intake
• Facial flushing and skin irritation may be triggered by extremes of temperature, sunlight, strenuous exercise, stress, spicy foods, caffeine, cheese, alcohol, and hot drinks
• Wear a broad-brimmed hat to protect the face when going out in the sun
• Use a high-factor sunscreen (sun-protection factor 30 or more) to the face and eyelids 15 to 30 minutes before going out in the sun and every 2 hours thereafter
• Advise the use of hypoallergenic emollients If the skin is dry
• British Association of Dermatologists has useful patient information

Management Category

• Refer patient to GP, if a new diagnosis
• Normally no referral to ophthalmology
• Urgent referral to an ophthalmologist if keratitis is severe

Possible management by Ophthalmologist

• Topical steroid if no risk of corneal perforation
• Systemic immunosuppression