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Lid margin inflammation – Blepharitis

The following information provides a guide for GPs on how to manage or make a referral for presentation of Lid margin inflammation – Blepharitis, Blepharokeratoconjunctivitis (blepharitis affecting the eye).

  • Low risk pathology

    • Mild to moderate signs and symptoms: red lid margins, frequent chalazia, slightly red or sore eyes, frequent blinking 
    • No concerns about vision 

     

    Do not refer
    Advise on self-care

  • Late

    • If also concerns about vision and age 5 years or older

     

    Refer to local optometrist for GOS sight test

  • Potential Serious Pathology

    Any of:

    • Severe symptoms (eg very painful and red eye) and signs 
    • Visible localised clouding/whiteness of cornea 
    • Suspected reduced vision in younger child or confirmed reduced vision in older child 
    • No improvement after one month of treatment 

     

    Urgent referral to Acute Eye Clinic

GP Management

Self-care plus: Oc Chloramphenicol 1% to rub into the lid margins twice daily for 2 weeks (if child not co-operative, G Chloramphenicol 0.5% to instil into conjunctival fornix twice daily for two weeks)

Artificial tears (e.g. carmellose, sodium hyaluronate as required up to four times daily

Under 2 years: oral erythromycin 125mg twice daily, for three months.

2 years and over: oral erythromycin 250mg twice daily for three months

12 and over: doxycycline 100mg once daily for three months

Note: antibiotics can be long-term maintenance, if symptoms recur after initial three month course

 

Referral information

Always include:

  • Child’s date of birth
  • Address
  • Child’s social worker details (including Borough), if any
  • Parent/carer contact phone number and email

 

Self-care & advice

  • Warm lid compresses
  • Lid margin cleaning
  • Over the counter artificial tears

 

Further assistance

This pathway has been produced by Moorfields Eye Hospital NHS Foundation Trust to help clinicians manage the healthcare of Children and Young People. However, if you need to contact a Paediatric clinician, please see below for contact details:

Moorfields Eye Hospital:

Paediatric helpline: 0207 2533411 extn 4569, Mon- Fri 10:00am-13:00pm then 14:00pm-16:00pm

 

video transcript
To clean the eyelids the first step is to do a warm compress which softens the debris on the eyelids making it easy to clean off.
Place a clean face cloth under a hot tap, nice and hot but not hot enough to burn or be uncomfortable. Wring it out and hold the hot compress on top of the closed eyes for one or two minutes.
If the cloth becomes cool, warm under the tap again, wring and replace it on the closed lids.
Next we perform the cleaning for older children we use a moistened cotton pad. This can be moistened in warm tap water or by using a weak solution of baby shampoo or bicarbonate of soda.
Squeeze out any excess moisture.
First you clean the back edge of the eyelid. Pull down the lower lid and run the bud firmly but gently along the thin line of skin behind the lashes four or five times.
 Do the same for the top lid putting it up and away from the eye. Then we clean the lashes. For the top lid, close the eyes firmly and scrub vigorously at the base of the lashes doing a small part of the lid at a time and moving gradually along the width of the lid to do all the lashes.
In the same movement to use for brushing your teeth. Then open the eye, look up and repeat with the bottom lid lashes, again moving gradually along the lid to ensure all the lashes are clean.
Ideally older children should be taught to do this themselves.
For younger children we start again with a warm compress.  Then use a face cloth to clean the lid edges moistened in warm tap water or with a weak solution of baby shampoo or bicarbonate of soda.
After moistening wring out the cloth wrapped the cloth tightly around the index finger so it covers the length of the finger holding the rest of the cloth in the hand.
With the child's eyes gently closed lay the finger with the length of the cloth along the lashes apply gentle pressure towards the eye and wipe up in a sweeping motion two to three times to clean the upper lid.
The gentle pressure towards the eyes will allow the eyelids to turn out a little so that the back edge of the eyelids are cleaned. Then wipe down two or three times in the same way to clean the lower lid.
To clean the base of the lashes; with your child's eyes tightly closed use the length of the the finger covered by the cloth to rub quite vigorously along where the lashes come out at the skin moving along the eyelids so that all areas are cleaned.

Last updated: April 2021