Blepharitis - Treating blepharitis

Blepharitis cannot usually be cured, but the symptoms can be controlled with good eyelid hygiene.

Blepharitis is a long-term (chronic) condition. Most people experience repeated episodes, separated by periods with no symptoms.

Eyelid hygiene

It's important to clean your eyelids every day if you have blepharitis, whether or not you currently have any symptoms or are using one of the medications mentioned below. Good eyelid hygiene can help to ease your symptoms and prevent it happening again.

Follow the steps below to keep your eyelids clean:

• Apply a warm (but not hot) compress to your closed eyelids for 5 to 10 minutes to help melt the oils that may have built-up in the glands behind your eyelids. A cloth or flannel warmed with hot water will usually be fine, although special eye packs that are heated in the microwave are available to buy.
• Gently rub your closed eyelids vertically and horizontally with your finger or a cotton wool bud to help loosen any crusting, and push out any oils that may have built up.
• Use a cloth or cotton bud with warm water and a small amount of cleaning solution (see below), and gently wipe the edge of your eyelids to clean them. Try to avoid touching your eye and don't clean the inside of your eyelids, as this can irritate them.

These steps should be carried out twice a day at first, then once a day when your symptoms have improved.

Try to avoid wearing eye make-up, particularly eyeliner and mascara, as this can make your symptoms worse. If you do wear eye make-up, make sure it is a type that washes off with ease so you can clean your eyelids every day more easily using the method described above.

Cleaning solution

There are many recipes for cleaning solutions and the best proportions or products to use can vary, depending on the individual.

A popular recipe involves pouring a pint of boiled water into a bowl, adding either a drop of baby shampoo or tea tree shampoo – or a teaspoon of bicarbonate of soda – and allowing it to cool before using. You could also use a commercial eyelid-cleaning solution.

Your GP or pharmacist can advise you about suitable cleaning solutions, although you may need to try more than one product to find one that suits you.

Topical antibiotics

If you have blepharitis that does not respond to regular cleaning, you may be prescribed a course of antibiotic ointments, creams or eye drops (topical antibiotics). You will usually need to use these for around four to six weeks.

Ointments and creams should be rubbed gently onto the edge of your eyelids, usually several times a day at first, using either clean fingers or a cotton bud. Once your condition begins to improve, you may only need to do this once a day, usually at night after cleaning your eyelids using the method outlined above.

Cautions

You should try to avoid wearing contact lenses when using antibiotic eye drops, as the drops may build-up behind the lenses and irritate your eye. Let your GP know if you want to keep wearing contact lenses, as they may recommend preservative-free drops that are less likely to irritate your eyes. 

If you are using more than one type of eye drop at the same time of day, leave at least five minutes before applying the second type of drops to your eyes.

You may experience some mild stinging or burning when applying antibiotic ointment or drops, but this should pass quickly. Do not drive if the ointment blurs your vision.

Oral antibiotics

You may be prescribed antibiotics to take by mouth once or twice a day if your blepharitis does not respond to other treatments. Oral antibiotics may also be recommended at the start of your treatment if it's thought that rosacea is aggravating your symptoms.

Most people respond well within the first few weeks of treatment, although you may need to take them for up to three months. It's important for you to finish the course of antibiotics, even if your symptoms get better.

Cautions

Some oral antibiotics used to treat blepharitis have been known to make people more sensitive to the effects of the sun. Therefore, while you are taking them, you should avoid prolonged exposure to sunlight and using sun lamps or sun beds.

Oral antibiotics can also sometimes affect unborn and developing babies, as well as young children, so they are not normally used to treat children under 12 years of age or women who are pregnant or breastfeeding.

Side effects of oral antibiotics are rare because the dose is relatively low. However, they may include vomiting, diarrhoea and, in women, yeast infections.  

Treating other conditions

Depending on the suspected cause of your condition and any other symptoms you have, you may also need additional treatment.

For example, if you have seborrhoeic dermatitis or dandruff, you may need to use an anti-dandruff shampoo on your scalp and eyebrows.

If you have dry eye syndrome, which frequently occurs alongside blepharitis, you may need separate treatment for this, such as "artificial tear" eye drops.