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Treatment Options - Blepharitis FoundationYour resource for red eyes

Treatment Options

The basic treatment of blepharitis is a combination of lid scrubs and medication. Lid scrubs are used on a daily basis. Medication is used periodically. There are also some adjunct treatments which can add to, and sometimes, improve the basic treatment.

Lid Scrubs

This treatment is best performed in the shower or at the sink. You may keep a bottle of baby shampoo (name brand or store brand) in the shower. Wet a terry cloth washcloth with warm tap water. Apply a few drops of baby shampoo to the washcloth to create a soapy solution. Close the eyes and scrub the lashes for 5 to 10 seconds. Rinse off the soapy solution and dry the eyes with a towel. Lid scrubs can be performed at the sink if you prefer. Some commercial lid scrub products are available in pharmacies without a prescription. These include EyeScrub® and OcuSoft®. These are similar to baby shampoo but lack the perfume and preservative. They may be beneficial for extremely sensitive eyes. Commercial lid scrub products may be available in bottles or in individual foil packs. Eye makeup removers provide a non-soapy alternative for removing debris from the eyelids. Almay, and other cosmetic companies, market eye makeup remover pads in plastic jars which contain 80 pads. The non-oily formula, which contains benzyl alcohol, is usually more effective than the moisturizing formula.


Antibiotic/steroid ointments, or eye drops, rubbed into the eyelids at bedtime will usually have a dramatic effect on the symptoms of blepharitis. These medications require a doctor’s prescription. The drops or ointment should not be instilled in the eye. Rather, they should be rubbed into the eyelids with the eyes closed using a clean finger. If a little bit of medicine gets in the eye, it is OK. These medications are meant to be instilled in the eye for conditions other than blepharitis. To treat blepharitis, we want to deliver these medications where they are needed, that is, to the eyelid margin. Either drops or ointment may be used. Ointments may deliver the medication to the eyelids for a longer period of time. On the other hand, drops do not produce an ointment film. Some examples of steroid/antibiotic medications include TobraDex® eye ointment or eye drops, Zylet® eyedrops, Maxitrol® oinment or eye drops and Pred G® ointment. Some doctors prescribe antibiotic drops or ointment without a steroid. Examples include erythromycin ointment, polysporin ointment, and AzaSite® eye drops. In general, antibiotic without the steroid would not be expected to be as effective as the combination products. Oral antibiotics may also be prescribed. Doxycycline, minocycline, and tetracycline are commonly used. They concentrate in the meibomian glands of the eyelids and help treat blepharitis through the systemic circulation, rather than direct application to the lid margins. While often effective, these medications can have some significant side effects. They are photosensitizer, so people taking them can sunburn more easily. They can change the bacterial flora of the gastrointestinal tract, so sometimes, opportunistic infections can develop. Women may get yeast infections from taking oral antibiotics.

Adjunct Treatment

Hot compresses help liquefy the meibomian gland secretions and make them easier to express. Gentle lid massage helps move the secretions from deep in the oil glands to the surface. After using hot compresses,the top lid is massaged in the downward direction, and the lower lid is massaged in the upward direction. This action is similar to squeezing toothpaste from a tube, with the top help down or up. Lid expression can be carried out by bringing the upper lid together and squeezing. This usually must be done in a doctor’s office, where anesthetic eye drops can be instilled to minimize discomfort.