1.2 Blepharitis, Anterior

eyes.nhs.scot/
Eyecare Guidelines/
Section 1 - Eyelids/
1.2 Blepharitis, Anterior

Date of last review: Due to be updated

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 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
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

Disclaimers

CEG disclaimer for guidelines awaiting update:

The Eyecare Guidelines area of the eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical decision support and is intended for use by ophthalmic healthcare professionals working in Scotland.

As such, the Eyecare Guidelines are not intended for use by the general public and do not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.

Before reading the Eyecare Guidelines or making any management decisions based upon them, all users should read the ‘supporting information’ page which gives more detail around the content of the Guidelines and useful website links [link to Supporting Information page].

Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation, and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways.

Users should note that Guidelines which have not yet been updated should be considered with caution. Where the Eyecare Guidelines contain links to other sites and/or resources provided by third parties, these links are provided for information only.

Accordingly, to the maximum extent permitted by law, the Eyecare Guidelines are made available on the basis of excluding all representations, warranties, conditions and other terms (including, without limitation, the conditions implied by law of satisfactory quality, fitness for purpose and the use of reasonable care and skill) which, but for this disclaimer, might have effect in relation to the Eyecare Guidelines.

CEG disclaimer for updated guidelines:

Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways. 

Updating the Eyecare Guidelines requires a continuous process; the date of the last review for each guideline will be clearly noted on each guideline. Users must consider these dates before using the guidance.

While the Common Services Agency (“NSS”) makes reasonable efforts to ensure that the information on the Eyecare Guidelines area of the Website is correct, the Website is provided ‘as is’ and NSS does not warrant the accuracy and completeness of the material on the Website. NSS may make changes to the Website at any time without notice. Some of the material on the Website may be out of date, and NSS makes no commitment to update such material. Users should note that some Eyecare Guidelines on the Website have not been updated for several years and should be considered with caution.

Where the Eyecare Guidelines section of the Website contains links to other sites and or resources provided by third parties, these links are provided for information only. NSS has no control over, and no liability in respect of, the content of these sites and resources.

Accordingly, to the maximum extent permitted by law, the Eyecare Guidelines area of the Website is made available by NSS on the basis that NSS excludes all representations, warranties, conditions and other terms (including, without limitation, the conditions implied by law of satisfactory quality, fitness for purpose and the use of reasonable care and skill) which, but for this disclaimer, might have effect in relation to the Website. 