Management of anterior blepharitis
Eyelid hygiene is the mainstay of therapy and controls symptoms and signs of anterior blepharitis if performed twice daily; see Patient information: Eyelid hygiene for anterior blepharitis for a printable patient handoutThe Royal Victorian Eye and Ear Hospital (RVEEH), 2023.
Place a warm compress (eg a face-washer or make-up pad soaked in warm water) onto the eyelids (with eyes closed). Keep the warm compress in contact with the eyelids for 2 to 5 minutes to soften the crusts.
Follow this with gentle scrubbing of the eyelid margin with:
- tea tree oil (melaleuca oil) solution (1 teaspoon of 100% tea tree oil in 100 mL of freshly boiled and cooled water) OR
- sodium bicarbonate solution (1 teaspoon in 500 mL of freshly boiled and cooled water) OR
- baby shampoo solution (5 drops in 100 mL of freshly boiled and cooled water) OR
- commercially available eyelid solution or wipes.
Repeat these steps twice a day.
Prepare a fresh solution each day.
Demodex mite infection may cause anterior blepharitis in patients older than 50 years; this infection cannot be cured and management is symptomaticShah, 2022. Gentle scrubbing of the eye lid margins with a diluted tea tree oil solution (see Patient information: Eyelid hygiene for anterior blepharitis), appears effective and has minimal adverse effectsLam, 2020Shah, 2022. If symptoms improve after 4 weeks of diluted tea tree oil scrubs, continue therapy. If symptoms do not respond, seek expert advice.
The efficacy of topical antibiotics for anterior blepharitis is uncertain. However, if symptoms are not controlled despite adequate eyelid hygiene and if secondary bacterial infection is suspected, consider a trial of chloramphenicol eye ointment in addition to the eyelid hygiene measures.