Blepharitis medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(32 intermediate revisions by 7 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Blepharitis}}
{{Blepharitis}}
{{CMG}} {{AE}} {{SR}}
{{CMG}}; {{AE}} {{SR}}, {{SaraM}}
 
==Overview==
==Overview==
Pharmacologic medical therapies for blepharitis include either antimicrobial drops or ointments. [[Azithromycin]] is the preferred regimen for empiric therapy.  Specific treatment for blepharitis depends on the causative pathogen and whether there is an underlying cause (dry eye, ocular rosacea, or meibomian gland dysfunction).
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919  }} </ref><ref name=Blepharitis PPP 2013> Blepharitis. American Academy of Ophthalmology. (2013). http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 </ref>


==Medical Therapy==
==Medical Therapy==


::*'''1. Empiric antimicrobial therapy'''<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref>
===General Management===
:::*'''Blepharitis'''
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. As blepharitis is a [[chronic]] disease, eyelid hygiene and regular cleaning must be performed even after an acute exacerbation has resolved. General management of blepharitis includes:<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919  }} </ref><ref name="pmid26031204">{{cite journal| author=Arita R, Morishige N, Shirakawa R, Sato Y, Amano S| title=Effects of Eyelid Warming Devices on Tear Film Parameters in Normal Subjects and Patients with Meibomian Gland Dysfunction. | journal=Ocul Surf | year= 2015 | volume= 13 | issue= 4 | pages= 321-30 | pmid=26031204 | doi=10.1016/j.jtos.2015.04.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26031204  }} </ref><ref name="pmid23118519">{{cite journal| author=Benitez-Del-Castillo JM| title=How to promote and preserve eyelid health. | journal=Clin Ophthalmol | year= 2012 | volume= 6 | issue=  | pages= 1689-98 | pmid=23118519 | doi=10.2147/OPTH.S33133 | pmc=3484726 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23118519  }} </ref>
::::*Preferred regimen: [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days
*Warm compresses: heat can liquefy the abnormal solidified [[meibomian glands|meibomian secretions]] and increase the quantity of secretions.
::::*Alternative regimen (1): [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks
*Eyelid cleansing: gentle washing of the lashes and [[eyelid|eyelid margins]] with warm water, eyelid scrub solutions, or baby shampoo to remove the accumulated material.
::::*Alternative regimen (2): [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks
*Eyelid massage: massage may help empty the [[meibomian glands]] and improve secretion.
::::*Alternative regimen (3): [[Erythromycin]]ophthalmic ointment qhs for 2 weeks
*Antibiotics (topical and/or systemic): antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause. It is important to consider eyelid margin hygiene before applying the [[topical|topical therapy]].
::::*Alternative regimen (4): [[Metronidazole]] 2% gel bid for 1-2 weeks
*Topical anti-inflammatory agents (e.g., [[corticosteroids]], [[cyclosporine]])
::::*Note: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months may be helpful in some cases of posterior blepharitis
 
::*'''2. Specific considerations'''
===Antimicrobial Regimens===
:::*'''2.1 Meibomian gland dysfunction''':
*'''Blepharitis'''<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref>
::::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks.
:*'''1. Empiric antimicrobial therapy'''
::::*Alternative regimen (1): [[Erythromycin]] 250-500 mg PO qd for 3 weeks {{or}} [[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{or}} [[Azithromycin]] 1 g PO once per week for 3 weeks
::* Preferred regimen (1): [[Bacitracin]] topical one or more times daily or at bedtime for a few weeks
::::*Note: [[Tetracyclines]] are contraindicated among pregnant women, nursing women, and young children < 8 years of age
::* Preferred regimen (2): [[Erythromycin]] topical one or more times daily or at bedtime for a few weeks
:::*'''2.2 Dry eye'''
::* Alternative regimen (1): [[Metronidazole]] topical (for cases unresponsive to [[Bacitracin]] or [[Erythromycin]])
::::*Preferred regimen: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months
::* Alternative regimen (2): [[Tobramycin]]/[[Dexamethasone]] ophthalmic suspension
:::*'''2.3 Ocular Rosacea'''
::* Alternative regimen (3): [[Azithromycin]] sustained release
::::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks {{or}} ([[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks) {{or}} ([[Azithromycin]] 1 g PO once per week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks)
::* Note (1): Cure is usually not possible with blepharitis. Eyelid hygiene may provide symptomatic relief for both anterior and posterior blepharitis.
::*'''3. Pathogen-directed antimicrobial therapy'''
::* Note (2): [[Cyclosporine]] topical drops 0.05% may be helpful in some patients with posterior blepharitis.
:::*'''3.1 Staphylococcus spp.'''
:*'''2. Specific considerations'''
::::*Preferred regimen: [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks {{or}} [[Erythromycin]]ophthalmic ointment qhs for 2 weeks {{or}} [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days {{or}} [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks
::*'''2.1 Meibomian gland dysfunction'''
:::*'''3.2 Demodex folliculorum'''
:::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks.
::::*Preferred regimen: [[Metronidazole]] 2% gel bid for 1-2 weeks
:::*Alternative regimen (1): [[Erythromycin]] 250-500 mg PO qd for 3 weeks {{or}} [[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{or}} [[Azithromycin]] 1 g PO once per week for 3 weeks
::::*Alternative regimen: [[Ivermectin]] 200 microgram/kg once weekly for 2 weeks
:::*Note: [[Tetracyclines]] are contraindicated among pregnant women, nursing women, and young children < 8 years of age
::*'''2.2 Dry eye'''
:::*Preferred regimen: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months
::*'''2.3 Ocular rosacea'''
:::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks {{or}} ([[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks) {{or}} ([[Azithromycin]] 1 g PO once per week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks)
:*'''3. Pathogen-directed antimicrobial therapy'''
::*'''3.1 Staphylococcus spp.'''
:::*Preferred regimen: [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks {{or}} [[Erythromycin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days {{or}} [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks
::*'''3.2 ''Demodex folliculorum'''''
:::*Preferred regimen: [[Metronidazole]] 2% gel bid for 1-2 weeks
:::*Alternative regimen: [[Ivermectin]] 200 microgram/kg once weekly for 2 weeks


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Primary care]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Inflammations]]
[[Category:Disease]]
[[Category:Needs overview
{{WH}}
{{WS}}

Latest revision as of 20:38, 29 July 2020

Blepharitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Blepharitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Blepharitis medical therapy On the Web

recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Blepharitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

National Guidelines Clearinghouse

NICE Guidance

FDA on Blepharitis medical therapy

CDC on Blepharitis medical therapy

Blepharitis medical therapy in the news

Blogs on Blepharitis medical therapy

Directions to Hospitals Treating Blepharitis

Risk calculators and risk factors for Blepharitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2], Sara Mehrsefat, M.D. [3]

Overview

Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.[1]

Medical Therapy

General Management

Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. As blepharitis is a chronic disease, eyelid hygiene and regular cleaning must be performed even after an acute exacerbation has resolved. General management of blepharitis includes:[1][2][3]

  • Warm compresses: heat can liquefy the abnormal solidified meibomian secretions and increase the quantity of secretions.
  • Eyelid cleansing: gentle washing of the lashes and eyelid margins with warm water, eyelid scrub solutions, or baby shampoo to remove the accumulated material.
  • Eyelid massage: massage may help empty the meibomian glands and improve secretion.
  • Antibiotics (topical and/or systemic): antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause. It is important to consider eyelid margin hygiene before applying the topical therapy.
  • Topical anti-inflammatory agents (e.g., corticosteroids, cyclosporine)

Antimicrobial Regimens

  • 1. Empiric antimicrobial therapy
  • Preferred regimen (1): Bacitracin topical one or more times daily or at bedtime for a few weeks
  • Preferred regimen (2): Erythromycin topical one or more times daily or at bedtime for a few weeks
  • Alternative regimen (1): Metronidazole topical (for cases unresponsive to Bacitracin or Erythromycin)
  • Alternative regimen (2): Tobramycin/Dexamethasone ophthalmic suspension
  • Alternative regimen (3): Azithromycin sustained release
  • Note (1): Cure is usually not possible with blepharitis. Eyelid hygiene may provide symptomatic relief for both anterior and posterior blepharitis.
  • Note (2): Cyclosporine topical drops 0.05% may be helpful in some patients with posterior blepharitis.
  • 2. Specific considerations
  • 2.1 Meibomian gland dysfunction
  • Preferred regimen: Doxycycline 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks OR Minocycline 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks OR Tetracycline 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks.
  • Alternative regimen (1): Erythromycin 250-500 mg PO qd for 3 weeks OR Azithromycin 250-500 mg PO 1-3 times a week for 3 weeks OR Azithromycin 1 g PO once per week for 3 weeks
  • Note: Tetracyclines are contraindicated among pregnant women, nursing women, and young children < 8 years of age
  • 2.2 Dry eye
  • Preferred regimen: Cyclosporine 0.05% ophthalmic emulsion bid for 6 months
  • 2.3 Ocular rosacea
  • Preferred regimen: Doxycycline 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks OR Minocycline 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks OR Tetracycline 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks OR (Azithromycin 250-500 mg PO 1-3 times a week for 3 weeks AND Tacrolimus 0.1% topical bid for 3 weeks) OR (Azithromycin 1 g PO once per week for 3 weeks AND Tacrolimus 0.1% topical bid for 3 weeks)
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 Staphylococcus spp.
  • 3.2 Demodex folliculorum
  • Preferred regimen: Metronidazole 2% gel bid for 1-2 weeks
  • Alternative regimen: Ivermectin 200 microgram/kg once weekly for 2 weeks

References

  1. ↑ 1.0 1.1 Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T; et al. (2011). "The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction". Invest Ophthalmol Vis Sci. 52 (4): 2050–64. doi:10.1167/iovs.10-6997g. PMC 3072163. PMID 21450919.
  2. ↑ Arita R, Morishige N, Shirakawa R, Sato Y, Amano S (2015). "Effects of Eyelid Warming Devices on Tear Film Parameters in Normal Subjects and Patients with Meibomian Gland Dysfunction". Ocul Surf. 13 (4): 321–30. doi:10.1016/j.jtos.2015.04.005. PMID 26031204.
  3. ↑ Benitez-Del-Castillo JM (2012). "How to promote and preserve eyelid health". Clin Ophthalmol. 6: 1689–98. doi:10.2147/OPTH.S33133. PMC 3484726. PMID 23118519.
  4. ↑ "Blepharitis PPP 2013".
Retrieved from "https://www.wikidoc.org/index.php?title=Blepharitis_medical_therapy&oldid=1635234"