Effectiveness of lid hygiene in the management of blepharitis

Have you ever stopped to think about the evidence behind the treatments you offer your patients? How do you know that the treatment is right for them? 

Our Using evidence in practice series sets out a summary of that evidence for you, so that you know that there is a solid foundation behind the recommendations you make. 

Professor Roger Buckley HonFCOptom and Professor John Lawrenson FCOptom have written an explanation of the evidence behind the recommendations about lid hygiene in the Clinical Management Guideline on blepharitis.

What you should know

When considering the evidence on lid hygiene, three questions arise: Is lid hygiene effective in the management of blepharitis? Of the available methods, is there any evidence of greater efficacy of one method compared to another? Are there any adverse reactions associated with lid hygiene routines?

An extensive literature search, undertaken in June 2018, identified 13 studies that evaluated the effectiveness of lid hygiene in blepharitis of various aetiologies. Six of these studies used a randomised controlled trial (RCT) design. 

Compared to baseline, significant improvements were seen in symptoms and clinical signs for all methods used. There was insufficient evidence from comparative studies to make any recommendation based on the relative effectiveness of different methods of lid hygiene. However, the majority of studies evaluated were judged to have a high risk of bias.

In 2012, the Cochrane Systematic Review, Interventions for chronic blepharitis, concluded that lid hygiene provides symptomatic relief for both anterior and posterior blepharitis. It issued a call for more research to compare commercial products with conventional lid hygiene measures to determine their relative effectiveness.

Cost as well as clinical effectiveness is important and pre-prepared, impregnated sterile pads are not available on NHS prescription.

There is moderate quality evidence to support the use of lid hygiene as first line therapy for the management of blepharitis. Simple measures using proprietary lid wipes or mild detergent solutions have been shown to improve signs and symptoms for the majority of individuals. Practitioners should make patients aware of the options available. For example the convenience of commercial lid wipes versus the higher cost of these products.

There is a need for high quality research comparing specific lid hygiene techniques to support future evidence-based recommendations.