Blepharitis Treatment: When Hygiene Isn't Enough

If daily warm compresses and lid hygiene aren't controlling your symptoms, blepharitis treatment may need to escalate to prescription medications or procedural interventions guided by an eye professional.

NHS/GP pathway in the UK

In the UK, most patients start with a GP or community optometrist. If symptoms persist despite consistent hygiene, you may be referred to an ophthalmology clinic for specialist assessment and targeted treatment.

First line: Lid hygiene, lubricants, and risk-factor control.
Referral: Ongoing symptoms, recurrent styes/chalazia, or suspected MGD may prompt referral.
Urgent care: Seek same-day assessment for severe pain, marked light sensitivity, or vision changes.

Topical Antibiotics

Antibiotic drops or ointments applied directly to the lid margin are often the first prescription step, especially for anterior blepharitis.

UK note: Erythromycin ointment is commonly mentioned in US guidance but is not routinely available in the UK.
Azithromycin eye drops (Azyter): A prescription-only drop in the UK that contains azithromycin and is used to treat susceptible bacterial eye infections.
Why it helps: Azithromycin has anti-inflammatory effects and can reduce bacterial load, which may improve lid margin inflammation.

Oral Antibiotics

Doxycycline

Low-dose oral doxycycline is frequently prescribed for chronic posterior blepharitis (MGD) and ocular rosacea.

"At low doses, doxycycline acts primarily as an anti-inflammatory agent. It can improve the fluidity of the gland oil."

Courses are typically several weeks to a few months, depending on response. It can cause sun sensitivity and stomach upset.

Oral Azithromycin

Oral azithromycin is sometimes used as a second-line option for more severe or persistent posterior blepharitis that has not improved with conservative care.

Why it is chosen: Shorter courses and often fewer stomach side effects than some alternatives.
How it helps: Reduces bacteria and also calms inflammation on the eyelid margin.
Effectiveness: Studies suggest outcomes similar to (and sometimes better than) doxycycline for MGD.

There is no single standard dosing schedule for blepharitis—your clinician will tailor the regimen to your case.

Topical Steroids

For severe flare-ups with significant redness and swelling, a short course of mild steroid drops (e.g., Fluorometholone or Loteprednol) may be prescribed to "put out the fire" of inflammation. Steroids are generally not for long-term use due to risks of glaucoma and cataracts.

In-Office Procedures

Technology has advanced significantly in treating MGD. These procedures address the obstruction in the glands more effectively than home remedies.

Thermal pulsation device positioned on the eyelids in a clinical setting.

Thermal Pulsation (LipiFlow, iLux)

Precise heat and gentle pressure to melt and express blocked meibomian glands.

IPL treatment handpiece on a sterile clinic tray.

Intense Pulsed Light (IPL)

Targets abnormal vessels, heats glands, and reduces bacterial and mite load.

Low-level light therapy device positioned over closed eyes in a clinical setting.

Low-Level Light Therapy (LLLT)

Gentle light-based therapy that warms eyelids and supports gland function.

Micro-exfoliation device tip on a sterile tray.

BlephEx

Micro-exfoliation that removes biofilm and scurf from the eyelid margin.

Emerging and Experimental Treatments for Blepharitis

These options are newer, specialist-led, or still evolving. Evidence is growing and availability varies.

Demodex-targeted options: Newer drops and off-label approaches aimed at mite-related lid inflammation.
Gland-opening procedures: Techniques like meibomian gland probing that are still evolving.
Newer thermal systems: Devices designed to warm lids while the eyes remain open.

Read the full overview and evidence summary here: Emerging and Experimental Treatments.

FAQs

When do I need prescription treatment for blepharitis?

If symptoms persist after consistent lid hygiene or you have frequent styes or chalazia, it is time to see an eye professional.

Do antibiotics help blepharitis?

Sometimes. They can reduce bacterial load and inflammation, but they are not needed for every case.

What does an eye doctor do for blepharitis?

They assess the glands, rule out other causes, and may prescribe drops, oral medication, or in-office treatments.

Is IPL or LipiFlow worth it for MGD?

These treatments can help selected patients with gland dysfunction, but results vary and a specialist should advise.

How long does blepharitis treatment take?

Blepharitis is chronic. Symptoms can improve within weeks, but maintenance care is usually needed.