# Chronic blepharitis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAO Blepharitis Preferred Practice Pattern 2018 · Blepharitis - StatPearls - NCBI Bookshelf - disease-level clinical article (blepharitis-full.txt) · Bacitracin Ophthalmic Ointment USP, US prescribing information, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (DailyMed SetID 6ed2f2bd-9d2f-46af-a44c-95a02ca034de) · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - Verified date: 2026-08 ## Verified against - AAO Blepharitis Preferred Practice Pattern 2018 - Blepharitis - StatPearls - NCBI Bookshelf - disease-level clinical article (blepharitis-full.txt) - Bacitracin Ophthalmic Ointment USP, US prescribing information, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (DailyMed SetID 6ed2f2bd-9d2f-46af-a44c-95a02ca034de) - Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) ## Treatment metadata - Bacitracin — eye - Erythromycin — eye - Referral & safety-netting (no drug therapy) - Doxycycline — 50 mg — oral.solid ## Complete treatment card ```text CHRONIC BLEPHARITIS Sources: AAO Blepharitis Preferred Practice Pattern 2018 · Blepharitis - StatPearls - NCBI Bookshelf - disease-level clinical article (blepharitis-full.txt) · Bacitracin Ophthalmic Ointment USP, US prescribing information, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (DailyMed SetID 6ed2f2bd-9d2f-46af-a44c-95a02ca034de) · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Chronic redness, burning, itching, and a foreign-body sensation in the eyes [foreign body · itching · redness] - Symptoms are often worse in the morning after tears pool overnight - Light sensitivity or blurred vision when the tear film is badly disrupted [blurred vision · photophobia] - Crusting on the lashes is most noticeable right after waking [crusting] - Usually affects both eyes at once, though it can come and go - Rosacea often sits alongside the posterior form, inflaming the meibomian glands and the skin together SIGNS - what you find (8) - Collarettes (crusting at the lash base) point to a staphylococcal anterior blepharitis [crusting] - Widespread oily scaling of the lid margin suggests a seborrheic cause [scaling] - Redness, swelling, and dilated tiny vessels along the lid margin on slit-lamp exam [redness] - Lash loss, lash depigmentation, and misdirected lashes can accompany the anterior form - In posterior disease the meibomian glands look dilated, blocked, and capped with oil - Gentle lid pressure expresses thick, turbid secretions from capped meibomian glands - Red flag: it brings on conjunctivitis and dry eye disease; in severe cases there is loss of vision from superficial keratopathy or from new vessels across the cornea [dry eye · loss of vision] - Inflammation that persists atrophies the glands, thickens the lid margins and destabilises the tear film, which keeps the cycle of irritation turning TESTS (5) - A tear break-up time under 10 seconds is considered abnormal - Fluorescein staining can reveal punctate erosions of the cornea or conjunctiva from ongoing inflammation - Cultures from the lid margin are taken for cases that recur or resist treatment - Light microscopy of plucked lashes can confirm Demodex mites and their cylindrical dandruff - Biopsy is needed when structural change or asymmetry raises concern for malignancy IF NOT THIS - what else fits (6) - Ocular rosacea and seborrheic or contact dermatitis overlap closely with blepharitis - HSV blepharitis usually follows a prior herpes infection and causes painful lid vesicles - Molluscum contagiosum shows small dome-shaped bumps along the lid margin, mainly in children - Sebaceous or meibomian gland carcinoma can mimic chronic blepharitis when disease is one-sided or unresponsive - Cicatricial pemphigoid can cause conjunctival scarring, unlike ordinary blepharitis - Bacterial conjunctivitis and bacterial keratitis are also on the differential list Source StatPearls "Blepharitis" - disease-level clinical article Status traced to the source above Rx: Topical antibiotic to the lid margin | Topical antibiotic - no Egyptian product | Main treatment TOPICAL ANTIBIOTIC TO THE LID MARGIN 1. BACITRACIN [1st line] Adult Clean off all scales and crusts first, then spread the ointment evenly along the lid margins, 1 to 3 times daily x 2 to 8 weeks Peds Same application in children: lid margins cleaned first, ointment spread along them 1 to 3 times a day. The label sets no weight-based dose - it is applied to the lid, not swallowed. Choice Write this one. The source names bacitracin and erythromycin in the same sentence as equals, but erythromycin has no Egyptian eye product of any kind, so bacitracin is the only one of the pair a pharmacy here can dispense. Source Blepharitis - StatPearls - NCBI Bookshelf - disease-level clinical article (blepharitis- full.txt) - verbatim, for the indication and the course: "Antibiotic creams such as bacitracin or erythromycin can be applied to the lid margin for 2 to 8 weeks." | Bacitracin Ophthalmic Ointment USP, US prescribing information, INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION (DailyMed SetID 6ed2f2bd-9d2f-46af-a44c-95a02ca034de) - verbatim, for how to apply it: "The ointment should be applied directly into the conjunctival sac 1 to 3 times daily. In blepharitis all scales and crusts should be carefully removed and the ointment then spread uniformly over the lid margins." and for the indication: "For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms." Why The one topical antibiotic named for anterior blepharitis that a patient in Egypt can actually buy. Erythromycin, named in the same sentence, has no Egyptian eye product at all. Caution Lid hygiene is the treatment; the ointment is added to it. Warm compresses and cleaning the lid margins twice a day do more than any antibiotic here, and the label itself says to remove all scales and crusts before applying. The Egyptian pack also contains neomycin, which is one of the commonest causes of contact allergy on the eyelids. If the lids become redder, itchier or more swollen on treatment, suspect the drops before assuming the blepharitis is worsening, and stop them. Ointment blurs vision for a few minutes after application, so at bedtime suits most people. No contact lenses while treating. Blepharitis is chronic. Expect to control it rather than cure it, and expect it back after the course. Egypt NEOPOLYBACIN EYE OINT. 5 GM EIPICO 5.00 EGP -> ! also contains neomycin, polymyxin TOPICAL ANTIBIOTIC - NO EGYPTIAN PRODUCT 2. ERYTHROMYCIN [1st line] Adult Apply 0.5% ophthalmic ointment thin ribbon along lid margins at bedtime for 1-2 weeks combined with daily warm compresses and lid hygiene x 1-2 weeks Peds Apply thin ribbon of 0.5% eye ointment to lid margins at bedtime for 1 week Source AAO Blepharitis Preferred Practice Pattern 2018 Why Topical macrolide antibiotic ointment applied to the lid margins to reduce the bacterial component of blepharitis; supplements lid hygiene and warm compresses, which remain the foundation of treatment rather than being replaced by the antibiotic. Caution Erythromycin is not obtainable in Egypt in this form. Every erythromycin eye product is absent from the national product list entirely, all 16 oral products are marked withdrawn, and the only three live topical products are acne preparations. Prescribe bacitracin instead: the same sentence of the same source names the two as equals, and bacitracin is stocked here. Lid hygiene is the treatment; the ointment is added to it. Warm compresses and cleaning the lid margins twice a day do more than any antibiotic here. No contact lenses while treating. Ointment blurs vision for a few minutes after application. Egypt AKNEMYCIN 2% OINT. 15 GM MUP > HERMAL-... 5.00 EGP -> ? different route - not eye, discontinued ACNI-CARE 2% TOP. GEL. 20 GM SIGMA 6.50 EGP -> ? different route - not eye, discontinued ERYTHROCID 200 MG/5ML SUSP. 60ML CID 5.60 EGP -> ? different route - not eye, discontinued ERYTHROMYCIN PHARCO 200MG/5ML SUSP. 60ML PHARCO 7.50 EGP -> ? different route - not eye, discontinued AKNEMYCIN 2% SOLUTION 25 ML MUP > HERMAL-... 9.00 EGP -> ? different route - not eye, discontinued ETHYRONATE 200MG/5ML SUSP. 100 ML UNIPHARMA CO. > UNIPHARMA 9.50 EGP -> ? different route - not eye, discontinued ETHYRONATE 400MG/5ML SUSP. 100 ML UNIPHARMA CO. > UNIPHARMA 11.75 EGP -> ? different route - not eye, discontinued ACNI-CARE 2% LOTION 25 ML SIGMA 20.00 EGP -> ? different route - not eye, discontinued MAIN TREATMENT - choose one 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Blepharitis - disease-level clinical article (blepharitis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Unilateral or atypical blepharitis requires eyelid biopsy to rule out malignancy (basal cell carcinoma or sebaceous carcinoma). 4. DOXYCYCLINE [2nd line] Adult 50-100 mg once daily orally for 4-6 weeks for severe posterior blepharitis / meibomian gland dysfunction x 4-6 weeks Peds Use under 8 years only for a severe or potentially life-threatening infection, or where no better alternative exists - the risk is permanent tooth discoloration and enamel hypoplasia during tooth development. Where it is justified: 2.2 mg/kg every 12 hours, maximum 100 mg per dose. Source Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) Why A tetracycline with anti-inflammatory as well as antibacterial action at the lid margin. The Egyptian National Drug Formulary's doxycycline monograph (Antimicrobial, 2023) sets the paediatric threshold at 8 years, not 12: below that age it is reserved for severe infections that may threaten life, or for cases with no better alternative. Caution CONTRAINDICATED in pregnancy and breastfeeding - use lid hygiene alone, or refer. RESTRICTED under 8 years old. The Egyptian National Drug Formulary's doxycycline monograph (Antimicrobial, 2023) reserves use below that age for severe infections that may threaten life, or for cases with no better alternative. The risk is permanent tooth discolouration and enamel hypoplasia while teeth are still forming, and blepharitis is not that kind of infection. There is a photosensitivity risk and sun protection is required. Egypt DOXYCOST 50MG 30 TABS. PENTA PHARMA 51.00 EGP (1.70/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)