The Best Treatments for Blepharitis: From Prescription Options to Home Remedies
Key takeaways:
Blepharitis is a type of eyelid inflammation that causes uncomfortable symptoms like eyelid redness, swelling, and eye irritation.
There are prescription and over-the-counter treatment options for blepharitis, such as antibiotics, artificial tears, and supplements.
There are also effective home remedies for blepharitis including eyelid scrubs and warm compresses.
If you’ve been noticing that your eyelids sometimes get red, swollen, or itchy, then you may be experiencing blepharitis. This is a common eyelid condition that causes dandruff-like flakes to accumulate at the base of your eyelashes. Blepharitis can flare up when you least expect it and cause uncomfortable symptoms.
There are effective treatment options that can relieve symptoms of blepharitis and lower the risk of future flares. Here’s a look at the best treatment options for blepharitis — from prescription treatments to over-the-counter (OTC) options and home remedies.
What is blepharitis?
Blepharitis is an inflammatory condition that affects the edge of the eyelid, which is also called the eyelid margin. Your eyelid margin includes skin, hair follicles where your eyelashes grow, and tiny glands that produce oils that lubricate your eye (meibomian glands).
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XDEMVY (lotilaner ophthalmic solution) 0.25% is indicated for the treatment of Demodex blepharitis.
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It’s not clear why some people develop blepharitis, but bacteria, demodex mites, inflammation and your immune response may play a role.
There are two types of blepharitis:
Anterior blepharitis: This type develops on the front surface of the eyelids and can affect the eyelashes, eyelash follicles, and eyelid skin.
Posterior blepharitis: This type develops on the underside of the eyelid (closer to the eyeball) and affects the oil (meibomian) glands.
You can have both types of blepharitis at the same time. Anyone can develop an episode of blepharitis. But some people develop chronic blepharitis, which means they have episodes of inflammation that come and go.
People with chronic blepharitis can develop flares when they come into contact with things like cosmetics, allergens, and smoke. Skin conditions and certain medications can also trigger blepharitis.
But whatever triggers your flare, the result is often the same: itchy, red, and uncomfortable eyes. While it can take a while to fully recover from a blepharitis flare, treatment can help you feel more comfortable and speed up the healing process.
OTC treatments for blepharitis
OTC treatments for blepharitis not only help with blepharitis flares, they can also prevent future flares. Eye doctors recommend that people with blepharitis start a nightly eyelid care routine to help lower the risk of future blepharitis episodes. You can add some or all of these OTC and at-home treatments to your nightly routine.
Warm compresses
A warm compress can ease pain and irritation when you have an active flare. The warmth also helps soften the scales so you can remove them easier with an eyelid scrub. Warm compresses can also help keep your oil glands open and clear when you don’t have a flare.
You can buy a reusable warm compress or make one at home. To make a warm compress:
Put a cup of dry rice in a sock.
Microwave the sock for 10-15 seconds.
Next, place the compress over your closed eyes for about 10 minutes.
Finish by gently massaging your eyelids in a vertical motion to help the glands release any blocked oil.
Eyelid scrubs
After your warm compress and massage, it’s time to move onto your eyelid scrubs. Eyelid scrubs remove dirt, debris, and dead skin cells from your eyelid margin. These things can block your oil glands and trigger (or prolong) a flare.
You can buy pre-moistened, textured eyelid cleanser pads. Look for pads that are labeled as “lid scrubs” or “eyelid cleansers.” You don’t want wipes that are meant to remove makeup. When using your pads, keep your eyes closed and gently rub the pad back and forth over the base of your eyelashes about a dozen times.
You can also make your own eyelid scrub:
Mix one part no-tears shampoo (baby shampoo) or tear-free face wash with one part water.
Place some on your index fingertip and shut your eyes gently.
Gently rub your upper eyelid back and forth about a dozen times, right at the base of your eyelashes, with the shampoo.
Rinse with clean water.
Eyelid cleansers
Eyelid cleansers can help remove debris, bacteria, and mites from your eyelids. You can purchase eyelid spray that’s made for blepharitis. Look for a product that contains hypochlorous acid. Popular brands include Avenova and OcuSoft Hypochlor. Make sure to follow brand specific instructions on how to use these products.
Artificial tears
Artificial tears can help relieve symptoms of dry eye, which often happen with chronic blepharitis. You can use artificial tears as needed throughout the day. With recent recalls, it’s a good idea to talk with your eye doctor about which brands are safest to use and where you should purchase your artificial tears.
When using artificial tears, make sure to not touch the tip of the bottle to your eye or eyelid, otherwise bacteria can get into your bottle and put you at risk for infection. If you’re having trouble keeping the tip from touching your eyelid, opt for single use vials instead. If you’re using artificial tears more than four times per day, experts recommend using preservative-free artificial tears.
Omega-3 supplements
Omega-3 supplements aren’t just good for your triglyceride levels. They can also help relieve dry eye symptoms. Getting dry eye symptoms under control can lower your risk of future blepharitis flares.
In a large study of 32,000 women, people who ate a diet rich in omega-3 fatty acids were 17% less likely to develop dry eye disease.
Prescription treatments for blepharitis
Like OTC options, prescription treatments can help curb a flare. If you get frequent blepharitis flares, your eye doctor might recommend using some of these options long-term, to prevent future flares.
Xdemvy
Xdemvy (lotilaner ophthalmic solution) is a new prescription medication that targets demodex mites, which are associated with blepharitis. Xdemvy eye drops are used twice a day.
In a clinical trial, 60% of people using Xdemvy twice a day for 6 weeks had complete eradication of their demodex mites. Xdemvy can also improve symptoms of blepharitis like eyelid crusting and redness.
Antibiotic eye ointments
Antibiotic eye ointments like erythromycin can help remove bacteria from the eyelid margin. People usually apply antibiotic eye ointment at bedtime since the ointment is thick and will blur your vision. By lowering the amount of bacteria around the eyelid, you can treat blepharitis attacks and prevent future flares.
Steroid eye drops
Short courses of steroid eye drops or eye ointment can reduce eyelid inflammation and improve blepharitis symptoms. While steroids may be a good choice for a flare, they’re not an option for long-term blepharitis management. That’s because long-term steroid use can increase your risk of developing other eye conditions like increased eye pressure and cataracts.
Your eye doctor will give you a plan on how to slowly stop steroids over the course of several days. This will help you avoid rebound inflammation, a condition where eyelid inflammation flares back up when you stop using steroids. Keep in mind that these steroids are made to be used in and around your eyes. Never use OTC steroids in or around your eyes.
Intense pulsed light (IPL)
Intense pulsed light (IPL) therapy is a type of light therapy that your eye doctor can perform in their office. IPL targets irregular blood vessels (telangiectasias) on the eyelid margin. IPL prevents inflammatory cells from accessing the oil or meibomian glands on the eyelids. IPL keeps oil glands open and reduces bacteria on the eyelid margin. All of these things can help lower the risk of future blepharitis flares.
Thermal pulsation
Thermal pulsation devices are another tool your eye doctor can use in the office to help prevent future blepharitis episodes. These devices apply heat directly to the oil glands and are helpful if you’ve been diagnosed with meibomian gland dysfunction.
The LipiFlow Thermal Pulsation System uses an activator and a console to apply both heat and pressure to the meibomian glands. It lasts for about 12 minutes in total. TearCare is a warming device that’s used to heat the meibomian glands using adjustable temperatures. Your eye doctor will then use another device to manually release the oil from the glands. This procedure can take 20 minutes or longer.
The bottom line
Blepharitis is an inflammatory eye condition that can cause eyelid redness, swelling, and itching. Blepharitis is often chronic and has periods where symptoms come and go. Blepharitis home treatments include warm compresses, eyelid scrubs, and eyelid cleansers. Prescription treatments include topical antibiotics, Xdemvy, steroid drops, and in-office therapies.
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References
Biljana, M., et al. (2005). Relation between dietary n−3 and n−6 fatty acids and clinically diagnosed dry eye syndrome in women. The American Journal of Clinical Nutrition.
Enginyurt, O., et al. (2015). The prevalence of Demodex species and its relationship with the metabolic syndrome in women of Malatya province, Turkey. Jundishapur Journal of Microbiology.
Fowler, B. T., et al. (2023). Blepharitis. American Academy of Ophthalmology.
National Eye Institute. (2023). Blepharitis.
Tarsus Pharmaceuticals, Inc. (2023). Xdemvy - topical ophthalmic use [package insert].
U.S. Food and Drug Administration. (2023). FDA warns consumers not to purchase or use certain eye drops from several major brands due to risk of eye infection.
