Discussing the classification of blepharitis, James McCulley, M.D., noted four basic types: staphylococcal, seborrheic, primary meibomitis (MKC), and meibomian gland dysfunction. The pathophysiology of chronic blepharitis can be attributed to both biochemical abnormalities of the meibum as well as bacterial lipolytic exoenzymes, but not to a single bacterium. Dr. McCulley stressed that therapy should not be used to cure the disease but to provide relief and control. Mechanical and hygienic measures include hot compresses, massage, and lid scrubs. Recommended topical antibiotic treatments include bacitracin, fluoroquinolones, aminoglycides, and tetracyclines. Systemic antibiotics are only indicated in severe cases of acute bacterial blepharitis, secondary meibomianitis, and MKC. Recommended systemic antibiotics include tetracycline analogues (including minocycline), and macrolides.
Nothing new here that I can see but I think that this is a nice overview for patients and doctors alike. I really appreciate the acknowledgment of the importance of compresses, massages and scrubs in these lid diseases. I was also relieved to see Restasis NOT on the list of treatments. I've been hearing rumors of it being promoted for MGD treatment but to date I have seen no medical literature demonstrating efficacy for such an indication.