Lid hygiene - this is the mainstay of treatment and may be sufficient to control simple low-grade blepharitis. It should also be used regardless of the need for additional treatment. Lid hygiene should be carried out twice a day in the acute phase and once daily at other times. There are three main aspects to this:
Managing infection - if there is an infection despite adequate lid hygiene, you may consider antibiotics:
Topical antibiotics are advised first-line, particularly if signs suggest staphylococcal infection. Use for six weeks. Chloramphenicol ointment is first-line, with fusidic acid as an alternative.
Systemic antibiotics may be used if there is no response to topical treatment, or if there are signs of rosacea or meibomian gland dysfunction. Prescribe for 6-12 weeks. Options include doxycycline, lymecycline, tetracycline and oxytetracycline. Avoid if there is likely to be excessive exposure to the sun (risk of photosensitivity), in pregnant or breast-feeding women and in children under the age of 12. In individuals with chronic kidney disease, avoid if possible but, if they are essential, doxycycline is a safer option in this group (the others are excreted renally). Other risks associated with tetracycline use are benign intracranial hypertension, gastrointestinal disturbances and, in women, vulvovaginal candidiasis.
Repeated courses of antibiotics may be necessary.
Topical and oral azithromycin have been put forward as another potential treatment option but neither is currently routinely prescribed in the