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 

• 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