Blepharitis, Anterior

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 Fucidic 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