Blepharitis medical therapy: Difference between revisions

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


==Medical Therapy==
==Medical Therapy==
===Eyelid Hygiene===
===Eyelid Hygiene===
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.  
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.  
Common eyelid hygiene and cleaning techniques include:<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>
Common eyelid hygiene and cleaning techniques include:<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>
*Warm compresses (heat can liquefy the abnormal solidified [[meibomian glands|meibomian secretions]] and increase the quantity of secretions).
*Warm compresses (heat can liquefy the abnormal solidified [[meibomian glands|meibomian secretions]] and increase the quantity of secretions).
*Lid massage (massage may help empty the [[meibomian glands]] and improve secretion)
*Lid massage (massage may help empty the [[meibomian glands]] and improve secretion)

Revision as of 17:37, 13 July 2016

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

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

Eyelid Hygiene

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. Common eyelid hygiene and cleaning techniques include:[1][2]

  • Warm compresses (heat can liquefy the abnormal solidified meibomian secretions and increase the quantity of secretions).
  • Lid massage (massage may help empty the meibomian glands and improve secretion)
  • Lid washing (gentle washing of the lashes and eyelid margins with warm water, eyelid scrub solutions, or baby shampoo to remove the accumulated material)

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.

Antimicrobial Regimens

  • 1. Empiric antimicrobial therapy[3]
  • 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. "Blepharitis PPP 2013".

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