Date of last review: Due to be updated

Differential diagnosis 

  • Allergy
  • Dacryocystitis
  • Parasitic infestation
  • Preseptal cellulitis
  • Herpes (simplex or zoster)
  • Meibomian gland carcinoma (very rare, usually unilateral)

Possible management by Optometrist

Treatment

  • Lid hygiene (consisting of warm compresses, lid massage and lid scrubs) is the first line of management regardless of type of blepharitis
    •  Apply microwaveable reusable warm compresses two to four times daily for 5 to 10 minute intervals
  • Clean lid margins (but not beyond the muco-cutaneous junction)
    • Diluted baby shampoo (1:10) solution with a swab or cotton bud or commercial products e.g. dedicated lid cleaning solutions or impregnated wipes
      • Twice daily at first; reduce to once daily as condition improves
  • Treat any aqueous tear deficiency with lubricants
  • Consider topical antibiotics to the anterior lid for resistant cases
    • Ask if allergic to Chloramphenicol 
      • If not, supply Chloramphenicol 1% eye ointment 3 times daily for a week
      • If allergic to Chloramphenicol, or pregnant, supply Fusidic acid 1% liquid gel twice a day for a week
      • Long term intermittent maintenance may be required
      • If ineffective consider treatment as for Rosacea
        • PoM Antibiotics as for Rosacea require co-management with GP-  tetracyclines contra-indicated in children, pregnant women, breast-feeding women
  • Treat associated seborrhoeic dermatitis or dandruff
    • Refer to local Pharmacist for selenium sulfide or ketoconazole 2% shampoo (both available OTC)
  • Consider Demodex blepharitis if characteristic 'cylindrical dandruff' is present at roots of eyelashes or if blepharitis is refactory to treatment Demodex mites can be dose-dependently killed by:
    • weekly lid scrub with 50% tea tree oil (experienced practitioners only)
    • or OTC pre-prepared demodex-specific lid wipes

Advice

  • Explain it is a long-term condition that may flare intermittently
  • Explain lid hygiene needs to be performed indefinitely
  • Advise the avoidance of cosmetics, especially eye liner and mascara
  • Advise patient to return/seek further help if symptoms persist

Management Category

  • Normally no referral
  • Referral if three months of pharmacological therapy does not produce sufficient response

Possible management by Ophthalmologist

  • As above