Questionnaire/history: Burning, itching and/or crusting of the eyelids? Symptoms worse in the mornings? Onset and duration of symptoms? Unilateral or bilateral? Exacerbating factors (eg wind, make up, contact lenses)? Previous treatments and responses? Past medical history (eg recurrent hordeolum, eye trauma or surgery, contact lens intolerance, rosacea, seborrheic dermatitis, atopy)? Current medication? Drug allergies? Examination: Red, inflamed and crusted eyelid margins? Complications (eg chalazion/hordeolum, lash malposition, conjunctivitis and corneal defects)? Associated conditions (eg rosacea, seborrheic dermatitis)? Investigations: Investigations (such as swabs) not routinely required but may be appropriate if blepharitis is recurrent with severe inflammation, immunocompromise or no response to initial treatment Referral for biopsy may be indicated if an alternative cause (such as malignancy or autoimmune disease) is suspected Diagnosis: Anterior blepharitis (inflammation of the base of the eyelashes (located on the anterior margin of the eyelid)): - bacterial (usually staphylococci) - seborrhoeic Posterior (Meibomian) blepharitis (inflammation of the meibomian glands (often called meibomian gland dysfunction) Mixed anterior and posterior blepharitis Management: Advised: - Blepharitis is a chronic, intermittent condition which requires ongoing maintenance treatment and cure is generally not possible - Symptoms can usually be controlled with self-care measures such eyelid hygiene and warm compresses - The eyelid can be cleansed by wetting a cloth or cotton bud with cleanser (eg baby shampoo diluted 1:10 with warm water) and gently wiping along the lid margins to clear any lid debris - Eyelids should be cleaned twice daily initially, then once daily as symptoms improve In addition a warm compress (a clean cloth warmed with hot water) should be applied to closed eyelids for 5–10 minutes once or twice daily - compresses should not be too hot as this may burn the skin - Eyelid hygiene should be continued even when symptoms are well controlled to minimise number and severity of relapses - For posterior blepharitis, a brief gentle eyelid massage following the use of a warm compress can help improve expression of Meibomian gland secretions, care must be taken to prevent mechanical irritation, pressure on the eye area should be avoided in people with glaucoma - Eye make-up (especially eyeliner and mascara) should be avoided To visit https://www.nhs.uk/conditions/blepharitis and https://patient.info/eye-care/swollen-eyelid/blepharitis to read information about blepharitis - For anterior blepharitis consideration to prescribe a topical antibiotic (such as chloramphenicol) to be rubbed into the lid margin (frequency and duration of topical antibiotic treatment depending on the severity of the blepharitis and response) - For posterior blepharitis associated with Meibomian gland dysfunction and rosacea consideration of prescribing an oral antibiotics (eg doxycycline [off-label] or tetracycline [contraindicated in pregnancy, lactation and in children under 12 years]) - Treatment of associated condition (such as dry eye syndrome, seborrheic dermatitis or rosacea) - Review if symptoms persist, worsen or new features develop, if eyelid measures ineffective review of diagnosis and to consider the need for referral Reference(s): NICE CKS: Blepharitis Information for patient/carer(s): NHS Health A to Z: Blepharitis Patient UK: Blepharitis