Treatment: Lid hygiene and antibiotics 2016-10-28T15:56:31+00:00

Lid hygiene and antibiotics

Patients with blepharitis and meibomitis are advised to keep the eyelids clean and crust free by means of good lid hygiene. Not only can good lid hygiene prevent exacerbation of blepharitis or meibomitis, but it may also reduce the development of chalazia. The key to treating most types of blepharitis is regular eyelid cleaning once or twice a day, depending on the severity. Some cases with more severe blepharitis and meibomitis may require more complex treatment plans, including topical antibiotic ointment and longer term treatment with tetracycline based medication.

Lid hygiene not only removes the harmful products from the lid margin which make the eyelids red and eyes sore, but also also helps massage the oil-producing meibomian glands. This unplugs the openings of the glands at the lif margin and enables the oil to reach the tear film surface and improve the tear quality.

There are many different cleaning techniques to maintain good eyelid hygiene. These include:

  • Hot flannel soaking and cleaning twice daily
  • Eyelid wipes
  • Cotton wool buds dipped in cleaning solution

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N.B. Blepharitis and meibomitis seldom disappear completely and even with successful treatment, relapses may occur.

Eyelid hygiene techniques:

  • Hot flannel soaking and cleaning

Take a clean cotton flannel and soak it in hot water. Place the flannel over the eyes and soak for one minute. Then gently rub the eyelid margin and the eyelash roots to remove the skin and oil debris. This movement also helps to unblock the meibomian gland openings and the heat makes the oil more fluid. Combined, this allows the oil from the glands to better lubricate the tear film. You may find it most convenient to do this in the shower.

  • Eyelid wipes

Various commercially available eyelid wipes can be obtained from the local pharmacy. These are effective, but are more expensive than hot flannel soaking or cotton wool cleaning.

  • Cotton wool bud/ cotton wool pad cleaning

Another option is to dip cotton wool buds in a home-made cleaning solution and then gently clean the lid margin and lash roots.

Procedure:

  • Wash your hands
  • Make up one of the following solutions:

Baby shampoo

 Add two drops of baby shampoo to one cup of boiled, then cooled water.

Sodium bicarbonate solution

Add 1 teaspoon of sodium bicarbonate (cooking soda) to one cup of boiled, then cooled water.

  • Soak a cotton wool pad/ cotton wool bud (Q-tip) in one of the above solutions (note it should be warm, but not too hot)
  • Place the cotton wool pads on the eyelids and let them soak for about a minute to soften the crusts and clear the glands and warm the oil.
  • Gently but firmly wipe along the eyelash margin to remove the crusts and debris with the pad then with the cotton bud at the lashes. First go horizontally, then in an up and down direction, staying near the eyelash roots.

Do this twice daily when there is an exacerbation, otherwise once daily
If you have been prescribed antibiotic cream, put this along the lid and eyelash margin after lid bathing.
Lid hygiene may make the eyelids look a bit red for 15 minutes as it increases the circulation to the eyelids.

N.B. Do not touch the surface of the eye with the cotton bud, especially in front of the coloured part (iris) as you could cause a painful scratch (corneal abrasion)

Antibiotics

Topical antibiotic ointment (e.g. Chloramphenicol) placed on the eyelid margin twice a day is recommended when there is a mild exacerbation of blepharitis in order to treat associated low-grade bacterial infection.
Oral antibiotics of the tetracycline family, which are frequently used for acne and acne rosacea, are recommended when there is a moderate and chronic blepharitis with meibomianitis. These tetracycline-based antibiotics are used in smaller doses than they would be for a full infection, and are used for several months. Their mode of action includes antibacterial, but they are mainly beneficial for their pH-moderating properties in the oily glands and tear film.
They should be used in accordance with the oculoplastic surgeon’s instructions.