Blepharitis can be managed but it’s not curable. It is like dry skin or dry scalp in that respect. Treatment is prescribed in a ‘staircase’ or stepwise manner. The mainstay of all blepharitis treatment is heat and massage known as ‘Lid Hygiene.’
‘Lid hygiene’ is the term eye doctors use to describe a special way of treating the eyelids in blepharitis. This does not mean that your eyelids are dirty.
Warm compresses using a face flannel or muslin and warm tap water are used to dilate the blocked openings to the oil glands. This will soften the oil trapped within. You don’t need to boil water. A face cloth is better than cotton pads or buds. The flannel is thicker and can hold the heat for longer. Hold it over your closed eyes for 1-2 minutes, then rinse under warm water. With your eyes closed place the flannel over the lid margins and scrub along the eyelids. The pressure from your fingertips will help to express the oil. The abrasiveness of the flannel moving side to side will lift the flakes off the eyelashes. It is important to do this twice daily.
It is usual to prescribe a lubricating drop to use in conjunction with lid hygiene. The tear quality is poor due to lack of oil so the lubricating drops help to moisturise the eye. Blepharitis is not an infection so antibiotic drops do not work. Thicker gel lubricants last longer than drops but can blur the vision. It is often helpful to use drops in the day. You may apply them more often reserving the gel for evening application.
For severe cases and in patients with Rosacea, a 3-month course of Lymecycline 408mg or doxycycline 100mg once a day can be helpful. This can be extended or repeated depending on symptoms. These medicines are part of the tetracycline family and are well tolerated. Sometimes they can make you itchy in bright sunlight. If this occurs you must stop them.
Flax seed oil capsules may be helpful in alleviating blepharitis symptoms in some patients. They contain Omega 3 oils. This will reduce inflammation and help improve the flow of oil from the glands in the eyelids.
There are aids to help with lid heat and massage such as heat and moist chamber goggles, MiboFlow.