Date of last review: Due to be updated
Differential diagnosis
- Allergy
- Dacryocystitis
- Parasitic infestation
- Preseptal cellulitis
- Herpes (simplex or zoster)
- Meibomian gland carcinoma (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.
- Massage the closed eyelids in a circular motion along the length of each lid to aid expression of meibomian gland secretions
- 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.
- Use firm pressure with swab or cotton bud to express glands
- Treat any aqueous tear deficiency
- 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
Advice
- Explain it is a long-term condition that may flare intermittently
- 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