Ocular surface and dry eye · UK
Blepharitis treatment, without guesswork.
A stepladder plan by a specialist ocular surface consultant: daily lid hygiene, prescription drops, and in-office BlephEx, IPL, LipiFlow or XDEMVY for Demodex. All four device options under one roof, matched to your lid disease.
Why patients choose us
- 01
A specialist ocular surface clinic, not a general list
A named consultant ophthalmologist with a dry-eye and ocular surface interest, on a slit lamp with meibography, not a routine cataract list.
- 02
The right step of the ladder
Lid hygiene first, in-office devices second, prescription third. We match the technology to your lid disease, not the other way round.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private blepharitis care costs in London.
Indicative ranges across our partner clinics. Send us your symptoms and any previous treatment, and we quote firm figures across two or three options.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultant ophthalmology assessment with slit lamp and meibography | £220-£380 | 30-45 min | Same visit |
| BlephEx microblepharoexfoliation (both eyes) | £180-£280 | 10-15 min | Same visit |
| IPL for MGD (single session) | £250-£450 | 20 min | Same visit |
| IPL course of 4 sessions | £1,000-£1,800 | 4 visits | 10-12 weeks |
| LipiFlow thermal pulsation (both eyes) | £850-£1,600 | 15 min | Same visit |
| Oral doxycycline 100 mg, 3 month course | £30-£60 | Take home | Same day |
The journey
From enquiry to maintenance, step by step.
One team from your first message to the 6 to 8 week review and the long-term maintenance plan.
- 01
Before
You send us your history and symptoms
A short, confidential form. Burning, gritty eyes on waking, crusting, contact lens intolerance, any rosacea, previous LASIK or cataract plans.
- 02
Before
We come back with a recommendation
Within one working day: which clinic, which consultant, and whether you need BlephEx, IPL, LipiFlow or a Demodex workup. Indicative price. Honest either way.
- 03
Before
We book the slit lamp assessment
Usually within one to two weeks. Slit lamp, meibography, tear film analysis and, if cylindrical dandruff is suspected, a lash epilation sample for Demodex.
- 04
On the day
Arrival at the clinic
Arrival and a full ocular surface assessment. The consultant walks you through the mixed anterior and posterior picture and the stepladder plan.
- 05
On the day
The in-office treatment
10 minutes for BlephEx, 15 minutes for LipiFlow, 20 minutes per IPL session. Topical anaesthetic drops. No downtime, drive yourself home.
- 06
On the day
Home the same day
A written home regimen: warm compresses, lid scrubs, hypochlorous spray and any prescription drops or oral doxycycline course.
- 07
After
Review and maintenance
A 6 to 8 week review to check meibomian gland function and symptom score. IPL courses run to 4 sessions. Chronic disease needs a maintenance plan.
When it helps
The types of blepharitis we treat.
Blepharitis comes in flavours. Getting the type right is what stops months of futile drops and wipes.
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Anterior blepharitis, seborrhoeic type
Greasy, yellowish scurf on the lash base with an oily face and scalp. Responds well to daily lid hygiene and hypochlorous acid spray.
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Anterior blepharitis, staphylococcal
Hard, brittle collarettes at the lash base, sometimes with small ulcers and lash loss. Often needs a short topical antibiotic on top of hygiene.
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Demodex blepharitis
Classic cylindrical, waxy dandruff cuffs at the lash base. Confirmed on lash epilation. Treated with tea tree, in-office ZEST, or XDEMVY for refractory cases.
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Posterior blepharitis, MGD dominant
Notched, capped meibomian orifices with thick, toothpaste-like oil. Best served by IPL, LipiFlow or TearCare, with omega-3s and warm compresses.
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Mixed anterior and posterior
The commonest picture in adults. Needs a combined plan: hygiene for the anterior lid margin, thermal or IPL therapy for the glands.
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Rosacea associated
Facial flushing, telangiectasia, papulopustular rosacea with ocular involvement. IPL treats the skin and the lid margin. Oral doxycycline 3 months.
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Before LASIK or cataract surgery
Untreated blepharitis increases the risk of postoperative dry eye and, importantly, endophthalmitis. We insist on a clean lid margin before you book surgery.
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Red flag: sudden painful red eye
A sudden painful red eye with reduced vision, a corneal ulcer or preseptal cellulitis is an emergency, not a private booking. Go to eye A&E the same day.
The stepladder
Four steps, in order. Only escalate if the previous step is not enough.
Step 1 is home hygiene. Step 2 is a prescription. Step 3 is in-office devices. Step 4 is chronic maintenance and refractory referral.
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Daily lid hygiene
Warm compress for 5 minutes, then gentle lid margin scrub. Dilute baby shampoo works, but commercial wipes (Blephaclean, Blephasol, Ocusoft, TheraTears SteriLid) are gentler and reduce recurrence.
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Hypochlorous acid spray
Avenova and equivalents kill lid margin bacteria and Demodex without stinging. A 30 second spray on closed lids, morning and evening. The single best home add-on.
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Topical or oral antibiotic
Azithromycin 1.5% drops for a short pulse in staphylococcal disease. Oral doxycycline 100 mg once daily for 3 months in MGD and rosacea, for its anti-inflammatory effect.
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BlephEx microblepharoexfoliation
A 10 minute in-office rotating micro-sponge that deep-cleans the lid margin, biofilm and lash base, including Demodex debris. Repeat every 4 to 6 months.
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IPL, Intense Pulsed Light
M22 or E-Eye devices deliver pulsed light to the lower lid and cheek. A course of 4 sessions liquefies stagnant meibum, closes telangiectasia and reduces Demodex load.
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LipiFlow and TearCare
Vectored thermal pulsation heats the inner lid to 42.5C and expresses terminal duct obstruction in one 12 minute session. TearCare is the wearable equivalent, done under direct expression.
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Tea tree and Zocular ZEST
Tea tree oil at 5 to 50% concentration is Demodex-lethal. In-office Zocular ZEST uses an okra-based gel for a comfortable, non-stinging deep clean.
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XDEMVY (lotilaner) for refractory Demodex
A newer prescription drop, twice daily for 6 weeks, that eradicates Demodex mites where topical measures fail. Topical ivermectin is an off-label alternative.
Our vetted London network
The dry-eye clinics we recommend.
Moorfields Private Dry Eye and Ocular Surface, Cadogan Clinic, HCA The Wellington Ophthalmology, London Medical, One Welbeck Eye Care and Focus Clinics. Introductions are made privately once we understand your case.
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Consultant ophthalmologists with a dedicated ocular surface and dry-eye subspecialty interest
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Full slit lamp assessment with meibography and tear film analysis, not just a symptom questionnaire
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In-house BlephEx, IPL (M22 or E-Eye), LipiFlow or TearCare, so all four devices are available under one roof
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Clear referral routes for rosacea, Sjogrens workup and refractory Demodex when the ocular surface will not settle
Safety and honest expectations
What to expect, honestly.
The unspoken truth about blepharitis: it is a chronic condition, not a one-off cure. Here is what to plan for.
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It is a chronic condition, not a one-off cure
Blepharitis is managed, not cured. Even a good IPL or LipiFlow result needs daily home hygiene and a top-up plan or symptoms drift back within 6 to 12 months.
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IPL exclusions
IPL is not used on Fitzpatrick VI skin, recent tanning, active herpes simplex, isotretinoin in the last 6 months, or over recent skin cancer. Discussed before you consent.
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Post-IPL care
Mild transient erythema and sensitivity for a few hours. Sunscreen SPF 30 or above on the treated area for 4 weeks. No sunbeds during the course.
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Doxycycline side effects
Photosensitivity, oesophagitis if taken lying down, and reduced efficacy of the contraceptive pill in a small subgroup. Avoid in pregnancy and under 12s.
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Before LASIK or cataract surgery
Untreated lid disease increases the risk of endophthalmitis after intraocular surgery. Any competent surgeon will insist on 4 to 6 weeks of pre-treatment first.
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Contact lens wearers
Reduce lens wear during flares. Switch to daily disposables. Preservative-free artificial tears. Some patients need a lens holiday of 2 to 4 weeks.
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Underlying disease workup
Refractory or asymmetric disease should trigger a workup for rosacea, seborrhoeic dermatitis, atopic disease or Sjogrens syndrome, not just more devices.
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Refractory Demodex
Persistent cylindrical dandruff after tea tree and ZEST is the trigger for XDEMVY (lotilaner) or topical ivermectin, prescribed by the ophthalmologist.
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Red flags after treatment
A painful red eye with reduced vision, photophobia or a corneal ulcer needs an emergency eye assessment the same day, not a phone consultation.
Reading your ocular surface report
Your report in four parts. Read the last one first.
The letter your consultant sends you keeps the same shape whichever devices are used.
- 01 Header
Anterior, posterior or mixed, and severity
What kind of blepharitis you have (seborrhoeic, staphylococcal, Demodex, MGD) and how bad it is on the Efron or MGD grading scale.
- 02 Findings
Slit lamp, meibography and tear film
Scurf, collarettes, cylindrical dandruff, meibomian orifice notching, gland dropout on meibography, tear break-up time and osmolarity.
- 03 Plan
The stepladder, personalised
What you do at home (compresses, wipes, spray), any prescription drops or oral doxycycline, and which in-office devices are booked.
- 04 Impression
Review interval and maintenance
Read this first: when you are back for review (usually 6 to 8 weeks), the IPL course schedule, and the maintenance plan for the next 12 months.
Recognised by major UK insurers
Cover varies by insurer and by indication. IPL and LipiFlow are usually self-pay. We confirm cover before booking.
Ready to stop the burning and crusting?
Get matched with a London ocular surface consultant, this week.
Send us a short note about your symptoms. We come back within one working day with the right clinic, the right consultant, and firm prices for BlephEx, IPL, LipiFlow or a Demodex workup.
Frequently asked
Everything we get asked about blepharitis treatment.
Quick answers on Demodex, IPL, LipiFlow, doxycycline and pre-cataract preparation.
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What is the difference between anterior and posterior blepharitis?
Anterior blepharitis affects the front of the lid margin and the lash base, and is either seborrhoeic (greasy scurf), staphylococcal (hard collarettes) or Demodex (cylindrical dandruff). Posterior blepharitis, also called meibomian gland dysfunction (MGD), affects the oil glands inside the lid margin and causes evaporative dry eye. Most adults have a mixed picture, which is why single-device treatments so often disappoint.
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How do I know if I have Demodex blepharitis?
The classic sign is cylindrical, waxy dandruff at the base of the lashes, itchy lids that are worse in the morning, and rosacea or seborrhoeic dermatitis of the face. It is confirmed by epilating a few lashes and looking at them under the microscope. Treatment is tea tree oil, in-office Zocular ZEST, or for refractory disease XDEMVY (lotilaner) drops twice daily for 6 weeks.
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How much does blepharitis treatment cost privately in the UK?
An initial consultant ophthalmology assessment is around £220 to £380. BlephEx microblepharoexfoliation is £180 to £280 per session. IPL is £250 to £450 per session, or £1,000 to £1,800 for the recommended course of four. LipiFlow thermal pulsation is £850 to £1,600 for both eyes. A three-month course of oral doxycycline is £30 to £60. We confirm firm figures within one working day.
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How many IPL sessions do I actually need?
The evidence-based protocol is four sessions at 2, 4, 6 and 8 to 10 weeks, then a maintenance session every 6 to 12 months. Most patients notice symptomatic improvement after the second session. IPL is not suitable for Fitzpatrick V and VI skin, recent tanning, or patients on isotretinoin.
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Do I really need to treat blepharitis before cataract surgery or LASIK?
Yes. Untreated lid disease is a well-documented risk factor for endophthalmitis after cataract surgery and for poor outcomes and severe dry eye after LASIK. Any competent surgeon will insist on 4 to 6 weeks of pre-operative lid hygiene, and often BlephEx or IPL, before booking your operation. It is the single most important thing you can do to protect your eyes before intraocular surgery.
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Is blepharitis curable?
It is controllable, not curable. Blepharitis is a chronic inflammatory condition of the lid margin driven by biofilm, MGD, Demodex and skin conditions like rosacea. Even after a great response to IPL, LipiFlow or XDEMVY, you will need daily home hygiene (warm compresses, lid wipes, hypochlorous spray) and a top-up plan or symptoms will drift back within 6 to 12 months.
Related pages
Looking for something else?
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In-office incision and curettage, or steroid injection.
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Pterygium surgery
Surgical removal with conjunctival autograft.
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Blepharitis, condition guide
The condition explained, symptoms and self-care.
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Rosacea, condition guide
Facial and ocular rosacea, and its treatment.
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Dry eye syndrome
Aqueous and evaporative dry eye, and how they overlap with lid disease.
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