Blepharitis, flashers and floaters

6th April 2015 by NASGP

Blepharitis, flashers and floaters

If like me, Ophthalmology training in medical school seemed like a blur (and that was just the view through the fundoscope!), you’ll hopefully find this update on blepharitis and flashes and floaters helpful.


Taken from the BMJ 10 minute consultation series (BMJ 2012;345:e3328), this useful reminder summarises management of this common condition.


  • Look for bilateral, usually symmetrical scaly/crusty/erythematous eyelids, possibly with conjunctival injection and small yellow plugs on meibomian glands.
  • Rule out other pathology including:
    • Dermatological conditions around the eyes.
    • Chalazion (meibomian cyst).
    • Mis-directed eyelashes (trichiasis) or missing lashes (madarosis).


Blepharitis can be chronic, so ensure the patient understands that treatment may only control rather than cure symptoms.

  • Use warm water compresses to soften crust and scale.
  • Clean eyelids with cotton bud soaked in baby shampoo or bicarbonate of soda.
  • In resistant cases, use chloramphenicol/fusidic acid for presumed Staphylococcus infection.
  • Treat persistent meibomian cyst infections with oral doxycycline (100mg daily for 6w).

Flashes and floaters

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Dr Tony Hall-Jones, retired GP

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