Blepharitis Treatment

1. Avoidance of irritants
   I advise wearing wrap-around sunglasses (or glasses fitted with side-pieces) in bright light or wind, avoiding smokey conditions, taking regular breaks from looking at computer screens, limiting contact lens wear and drinking plenty of water.
 
2. Rigorous hygiene of the eyelids
   This is the mainstay of treatment and should be undertaken in the morning and evening for the first 2-3 weeks and then at least once every day indefinitely to keep the inflammation under control.
   There are 3 steps needed for effective lid hygiene:

    
   1. Heat application. Heat applied to the eyelids for 5 minutes softens the skin and any crusts that are attached to the eyelashes and helps to unplug the ducts of the meibomian glands. 
The EyeBag™ is a convenient and effective method of applying heat (www.eyebagcompany.com).
   2. Massage. With your eyelids closed, firmly massage the eyelids just next to the lid margin with your forefinger immediately after heat application. This helps to express the oily fluid from the meibomian glands, which then stabilises the tear film on the surface of the eye.
 Massage the upper eyelid and the lower eyelid gently towards the eye and repeat 5-10 times over about 30 seconds immediately following the application of heat.

   3. Cleaning. After heat application and massage, cleaning is most conveniently achieved with Blephaclean® wipes or Blephasol® solution on a cotton bud once to twice daily. These are not available on prescription, but can be purchased at your local pharmacy.

1. Lubricants. Artificial tears can help relieve irritation. They should be used at least 4 times a day to prevent rather than just relieve symptoms. There are many different artificial tear preparations to choose from. Lubricants are available on prescription and can be purchased over the counter at your pharmacy.
2. Omega 3. Diet has a significant effect on the ocular surface. Oily fish , containing the essential fatty acid Omega 3 is said to be very helpful. There is some evidence that Omega 3 in a more concentrated capsule form is beneficial. Salmon, fresh tuna, mackerel, sardines, trout and herring are all examples of oily fish.

Other treatments include:

1. Antibiotic ointment.
 In severe blepharitis an antibiotic ointment can be applied to the lid margins. This can reduce the bacteria contributing to eyelid margin inflammation and make it easier to control blepharitis using the treatment described above.
2. Oral antibiotics. 
If posterior blepharitis cannot be controlled with local treatment, a 6-12 weeks course of an oral antibiotic can improve the inflammation.
3. Steroid ointment or drops. These can be very effective, but do have potential side effects, including causing eye infections and glaucoma. They must only be used with guidance from an ophthalmologist.