Table 1 Management strategy for chronic tarsal conjunctivitis

1) Investigation by ophthalmology, including examination, swabs for chlamydia and biopsy (if necessary) to exclude other conditions.

2) Initiate treatment with a reasonable strength of topical steroid. Despite a rapid response of symptoms, continue on these drops for at least one month. Then slowly tail off over at least three months, titrating clinical features of tarsal conjunctival inflammation with strength and frequency of drops used. Don’t stop/tail off too quickly or symptoms and signs will recur.

3) Reduce as far as possible all facial products. This applies to facial wipes/make-up remover wipes/cosmetics/moisturising products.

4) On some occasions, the strength of topical steroid may have to be increased to control the symptoms when tarsal conjunctival inflammatory signs remain. Such resistance to treatment is to be expected if the underlying irritant is still being applied on and around the eyelids.

5) Elimination of the use of all products to the skin of eyes and eyelids is the best advice, but few women are prepared to consider this.