The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Blepharitis is a chronic inflammation of the eyelid margins, and one of the most common presentations in primary eye care. It can cause ocular discomfort, soreness, itching and symptoms of dry eye, but most cases can be managed with long-term eyelid hygiene measures. This Clinical Management Guideline outlines the aetiology, signs, symptoms and evidence-based recommendations for diagnosing and treating blepharitis. This includes non-pharmacological and pharmacological treatment options and when referral may be appropriate.
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What is blepharitis?
Blepharitis is a condition in which chronic (i.e. long-term) inflammation of the eyelid margins causes symptoms of eye irritation. Sometimes there may be no symptoms. There are two types of blepharitis, which sometimes occur together:
Anterior blepharitis affects the outer front edge of the eyelids, at the base of the eyelashes.
Posterior blepharitis, which is most commonly caused by Meibomian Gland Dysfunction (MGD), results when the condition affects the inside rims of the eyelids (just behind the eyelashes), which contain the meibomian glands. The meibomian glands produce a thin layer of oil which normally prevents the tears from evaporating too quickly. If these glands become inflamed, this process does not work properly.
Blepharitis is usually caused by the bacteria on the skin, but it can also be caused by mites (Demodex) which live in the eyelid glands.
How is blepharitis managed?
Cleaning the eyelids regularly (lid hygiene) may help reduce the symptoms for most people with either type of blepharitis. The optometrist may prescribe antibiotics, either in the form of eye drops or ointments (and in some cases antibiotics taken by mouth) can potentially lessen symptoms and are effective in clearing bacteria from the eyelid margins. However, there is no strong evidence that any of these treatments can completely cure the condition, and continuous ongoing treatment may be necessary.
Blepharitis (Lid Margin Disease) - 9 June 2026 The aetiology section has been extensively revised to provide updated prevalence data and a clearer description of the pathophysiology of each blepharitis subtype. The non-pharmacological and pharmacological management sections have been updated to include information on the effectiveness of automated eyelid debridement, intense pulsed light therapy, thermal pulsation therapy and topical corticosteroids in blepharitis management. The management category section has been amended to outline the appropriate pathway and level of urgency where meibomian gland carcinoma is suspected.
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