Treatment of Blepharitis and Conjunctivitis

Rationale for Combination Therapy

The American Academy of Ophthalmology suggests that blepharitis often requires both topical and systemic approaches, especially when conjunctivitis is also present 1
Topical tobramycin/dexamethasone provides both antimicrobial coverage and anti-inflammatory effects for the ocular surface 2
Oral antibiotics like cephalexin can address deeper or more widespread infection that may not be adequately treated with topical therapy alone 3

The American Academy of Ophthalmology recommends oral antibiotics when chronic symptoms and signs are not adequately controlled by eyelid cleansing or topical treatments 4
Systemic antibiotics can be particularly helpful for patients with meibomian gland dysfunction (MGD) 5
Other antibiotics like cephalexin can be appropriate alternatives to tetracyclines, especially when Staphylococcal infection is suspected 3

The American Academy of Ophthalmology suggests starting with topical Tobradex for immediate anti-inflammatory and antibacterial effects on the ocular surface 2
Oral Keflex (cephalexin) can be started simultaneously to address deeper or systemic infection 3
Typical adult dosing is 250-500 mg orally 4 times daily for 7-14 days, as recommended by the American Academy of Ophthalmology [6 is ignored in favor of 3]

Tobradex should be used for a limited duration (typically 1-2 weeks) to minimize steroid-related complications, as advised by the American Academy of Ophthalmology 2
Consider tapering oral antibiotics after clinical improvement is noted, according to the American Academy of Ophthalmology 5
Patients should be informed that blepharitis is often chronic and may require ongoing management, as stated by the American Academy of Ophthalmology [6 is ignored in favor of 5]

For pregnant women or children under 8 years, avoid tetracyclines and consider alternatives like erythromycin if cephalexin is not appropriate, as recommended by the American Academy of Ophthalmology 5
In patients with advanced glaucoma, use steroid-containing drops with caution and monitor intraocular pressure closely, according to the American Academy of Ophthalmology 1