Blepharitis
Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.
Clinical features
- Eyelids may burn, stick together (worse in the mornings) and can be itchy with flaky skin/debris
- Both eyes tend to be affected
- Conjunctivitis may be present
- Can be associated with flare-ups and remission periods
- Existing medical conditions associated include dry eye, seborrhoeic dermatitis and rosacea
- See under the heading 'styes' as to how blepharitis differs
Referral criteria
- Very swollen eyelids or systemic symptoms (i.e. those suggestive of orbital cellulitis)
- Suspected carcinoma (painless nodule/ulcer which may bleed)
- Suspected dermatological condition (such as eczema or allergic/contact dermatitis)
- Herpes infection or infestation of scabies/lice involving eyes
- Entropion or ectropion
Time frame to resolution
- Usually a chronic condition, however, symptoms can be managed with self-care measures in many instances
Management strategy
Non-pharmacological advice
- Good eyelid hygiene is essential, even when symptoms are well controlled. NHS recommends doing eyelid hygiene measures twice daily initially, then reducing to once daily. The eyelids should be cleaned to remove any debris from the lid margins, typically using a gentle product like a baby shampoo diluted with warm water
- NB proprietary eye cleansers specifically for blepharitis are also available
- NHS also mentions that a warm compress can be applied to closed eyes for around 10 minutes (the eyelid can also be massaged to express glands, if necessary. People with glaucoma should not apply pressure to the eye area)
- Eye make-up may exacerbate (avoid or ensure the product washes off readily without causing any trauma)
Pharmacological advice
- No OTC antibacterial pharmacological measures are advocated (in general, prescribed antibiotics may need to be considered when eyelid hygiene alone is not effective. This is something to explain to patients but would be beyond OTC product licences)
- Several proprietary eye hygiene products are available but these are not necessarily better than other hygiene measures (although some patients may prefer to purchase a product/consider them to be convenient option)
- A Cochrane systematic review of topical immunosuppressants for blepharitis in adults (updated May 2026) found that topical corticosteroids, with or without antibiotics, and ciclosporin may make little to no difference to the signs and symptoms of blepharitis at 4 to 12 weeks (low- to very low-certainty evidence), and concluded that conventional lid hygiene and warm compresses remain valid therapeutic options. This supports leading with lid hygiene rather than seeking a pharmacological product
- Pregnancy: provide non pharmacological advice and check individual proprietary hygiene products for guidance on suitability