Blepharitis

This is classified into two types:

• Anterior blepharitis—staphylococcal

• Posterior blepharitis—seborrhoeic and rosacea (more common)

Treatment

• Consider referral

• Eyelid hygiene is the basis of therapy for both types—clean with a cotton bud dipped in 1:10 dilution of baby shampoo or sodium bicarbonate solution or clean warm water, once or twice daily. Another strategy is to apply a warm water or saline soak or compress with gauze for 5 mins

• Artificial tears (e.g. hypromellose 1%) for dry eyes; avoid make-up and contact lenses

• Control scalp seborrhoea with medicated shampoos (e.g. ketoconazole)

• If persistent: short-term use of hydrocortisone 0.5% ointment

• If facial rosacea: doxycycline 100 mg (o) bd for 4–8 wks

• If infected (S. aureus): tetracycline 1%, framycetin 0.5% or chloramphenicol 1% ointment to lid margins 3–6 hrly for 4 wks and review

• If not controlled or lid abscesses: di(flu)cloxacillin or doxycycline