Efficacy of 1% Povidone-Iodine in the Treatment of Anterior Blepharitis—Randomized Single-Center Controlled Trial

<b>Background:</b> Anterior blepharitis (AB) is a chronic eyelid inflammation with no definitive cure. <b>Objectives:</b> To assess the safety and efficacy of a 1% povidone-iodine (PVI) ophthalmic solution lid scrub compared to formulated eyelid wipes in treating AB. <b>Design:</b> A prospective, randomized, controlled, observer-masked, paired-eye trial. <b>Methods:</b> Sixty-three AB patients were randomly assigned to a 30-day treatment in which one eye underwent a daily lid scrub with 1% PVI solution (1% PVI group), while the fellow eye was treated with formulated eyelid wipes (control group). Clinical outcomes, such as blepharitis signs, tear breakup time, and corneal staining, were evaluated at study enrollment and exit visits. Symptom assessments utilized the visual analog scale (VAS) per eye and the ocular surface disease index (OSDI) questionnaire. <b>Results</b>: Fifty-two patients (mean age 62.3 years, 53.8% females) completed the treatment, while seven patients were lost to follow-up, three were non-compliant, and one sustained an eye trauma. After 30 days, both the 1% PVI and control groups exhibited significant improvements in symptoms, blepharitis signs, and corneal staining (<i>p</i> < 0.05). The 1% PVI scrubs were equally effective as eyelid wipes in most outcomes (<i>p</i> = 0.480) and superior in alleviating eyelid erythema (<i>p</i> = 0.007). Only the 1% PVI group showed a positive correlation between OSDI and VAS score improvements (<i>r</i> (52) = 0.353, <i>p</i> = 0.01). No adverse events related to either treatment modality were reported. <b>Conclusions:</b> A 1% PVI solution is an effective, safe, and well-tolerated treatment option for AB and is superior to formulated eyelid wipes in several subjective and objective measures.