This guideline last updated 06/05/2022 17:38:53

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 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

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