Cosmetic

The treatment and control of blepharitis has a stepwise approach to keeping the eyelids clean. Cleaning the dirt and debris from the lids and lashes and reducing the bacteria from this area will improve symptoms. The goal is to gently clean the eyelids. Being too aggressive can cause more eyelid irritation. The basic steps are outlined below. You can tailor these basic steps according to how much your symptoms improve or worsen. Blepharitis typically has a fluctuating, up and down course.

Your symptoms likely will not improve immediately. You should stay diligent, however, because the improvement will only take place over a period of weeks and continue over weeks or months. If you stop the treatment, your symptoms can return, as this is a chronic condition that requires long-term management.

Warm Compresses

The goal of the warm compresses is to liquify and loosen the oil in the Meibomian glands, allowing it to reach the tear film. There are several ways of applying heat to your eyelids, the goal is to apply heat for 3-5 minutes at least once per day. One option is to wet a clean washcloth with hot water and wring it out until somewhat dry. After removal of eye make-up, place the washcloth over your closed eyes, and wet the washcloth again as often as needed so it stays hot. 

Another option is using a store-bought heat mask which can be warmed in the microwave, please be careful to test the temperature in order to avoid getting burned. Some heat masks are battery run or can be plugged in.

Eyelid Scrubs, Cleansers and Spray

In some cases, baby shampoo can be used to clean the eyelids after applying the warm compresses. Dilute the shampoo with some water. Gently clean the eyelids using one of the following: fingertips, a washcloth, cotton pads or cotton balls. (Patients should find the choice is best for their eyes.) Keep the eyelids closed and wash along the edges of the eyelids. Rinse the soap when finished. Name brand Johnsons’ Baby Shampoo is recommended because it is very gentle and least likely to cause irritation. Cleaning with baby shampoo can be performed once or twice a day, depending on the severity of your symptoms.

There are many different commercially available lid scrubs and cleansers that can be used instead of baby shampoo. Follow the instructions on the box for each product; the best moment to perform eyelid cleansing is after the warm compresses. It is important to avoid vigorous scrubbing as this can cause increased inflammation.

Eyelid sprays are frequently used instead of scrubs. The primary component is hypochlorous acid, which is an over the counter medication that can help decrease inflammation of the meibomian glands. Avenova and Hypochlor are some name brand examples. After removal of eye make-up and warm compresses, spray the solution onto closed eyelids. Then spread it onto your eyelashes lightly using a clean fingertip and let it dry. After it is dry, you can apply your usual moisturizing products. We recommend using the spray twice per day (morning and night).

Antibiotics

Your ophthalmologist may have you use antibiotics in the treatment of blepharitis. These can be prescribed orally, or as a topical ointment or drop. If you are prescribed an ointment, please put a small amount of ointment on a clean fingertip, and gently apply to the base of your eyelashes. Do this as many times a day as recommended by your doctor. If prescribed an oral antibiotic, please take with foods.

Eye Drops

Artificial tears are always helpful in the treatment of blepharitis, as this entity generally causes dry eyes. These drops are sold over the counter. There are many different brands, some with or without preservatives. Please discuss with your doctor to determine which artificial tears are best for you.

Your doctor may also prescribe topical medications, or a short course of steroids designed to decrease inflammation and improve blepharitis and dry eye symptoms.

Office-Based Procedures

There are several procedures that can be performed in clinic that may be helpful in the treatment of blepharitis. They are mostly designed to express the oil out of the meibomian glands. This can be done manually or using a device called LipiFlow, which is designed to safely heat the palpebral surfaces of the upper and lower eyelids while simultaneously applying graded pulsatile pressure to the outer eyelid surfaces, analogous to a “deep cleaning” performed at the dentist. You would need to be referred to a specialized dry eye clinic to determine if these procedures are an option for you.