eye disorders
Blepharitis
Treatment of Blepharitis
Antimicrobials for acute ulcerative blepharitis; warm compresses and sometimes topical corticosteroids for acute nonulcerative blepharitis For chronic blepharitis, treatment of keratoconjunctivitis sicca, warm compresses, cleansing of eyelids, and sometimes topical or systemic antibiotics as clinically indicated Acute ulcerative blepharitis is treated with an antibiotic ointment (eg,bacitracin/polymyxin B,erythromycin, orgentamicin0.3% 4 times a day for 7 to 10 days). Acute viral ulcerative blepharitis is treated with systemic antivirals (eg, for herpes simplex,acyclovir400 mg orally 3 times a day for 7 days; for varicella zoster,famciclovir500 mg orally 3 times a day orvalacyclovir1 g orally 3 times a day for 7 days). Treatment of acute nonulcerative blepharitis begins with avoiding the offending action (eg, rubbing) or substance (eg, new eye drops). Warm compresses over the closed eyelid may relieve symptoms and speed resolution. If swelling persists>24 hours, topical corticosteroids (eg,fluorometholoneophthalmic ointment 0.1% 3 times a day for 7 days) can be used. The initial treatment for both meibomian gland dysfunction and seborrheic blepharitis is directed toward the secondary Keratoconjunctivitis Sicca . Tear supplements during the day, bland ointments at night, and, if necessary, punctal plugs (inserts that obstruct the puncta and thus decrease tear drainage) are effective in most patients. If needed, additional treatment for meibomian gland dysfunction includes warm compresses to melt the waxy plugs and occasionally eyelid massage to extrude trapped secretions and coat the ocular surface. If needed, additional treatment for seborrheic blepharitis includes gentle cleansing of the eyelid margin (lid scrubs) twice a day with a cotton swab dipped in a dilute solution of baby shampoo (2 to 3 drops in ½ cup of warm water) or with commercially available wipes and washes that contain ingredients such as a gentle eyelid cleanser, tea tree and coconut oils, or hypochlorous acid 0.01%. A topical antibiotic ointment (erythromycin,bacitracin/polymyxin Bor drops such asazithromycin1.0% or 1.5% orsulfacetamide10% twice a day for up to 3 months) may be added to reduce bacterial counts on the eyelid margin when cases are unresponsive to weeks of eyelid hygiene. In some cases, oralazithromycin500 mg per day for 3 days in three cycles with 7-day intervals or atetracycline(eg,doxycycline100 mg orally twice a day tapered over 3 to 4 months) may also be effective because it changes the composition of meibomian gland secretions or alters the composition of skin bacteria. 