Dawaa Reference

chronic

Chronic blepharitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 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 against4 documents
  • 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 date2026-08

Presentation reference

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

SourceStatPearls "Blepharitis" - disease-level clinical article

Presentation findings are 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

Topical antibiotic to the lid margin

1st line

Formeye

Adult dose and duration

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

Paediatric dose

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.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
NEOPOLYBACIN EYE OINT. 5 GM! also contains neomycin, polymyxinEIPICO5.00 EGP

TOPICAL ANTIBIOTIC - NO EGYPTIAN PRODUCT

2

ERYTHROMYCIN

Topical antibiotic - no Egyptian product

1st line

Formeye

Adult dose and duration

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

Paediatric dose

Apply thin ribbon of 0.5% eye ointment to lid margins at bedtime for 1 week

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
AKNEMYCIN 2% OINT. 15 GM? different route - not eyediscontinuedMUP > HERMAL-GERMANY5.00 EGP
ACNI-CARE 2% TOP. GEL. 20 GM? different route - not eyediscontinuedSIGMA6.50 EGP
ERYTHROCID 200 MG/5ML SUSP. 60ML? different route - not eyediscontinuedCID5.60 EGP
ERYTHROMYCIN PHARCO 200MG/5ML SUSP. 60ML? different route - not eyediscontinuedPHARCO7.50 EGP
AKNEMYCIN 2% SOLUTION 25 ML? different route - not eyediscontinuedMUP > HERMAL-GERMANY9.00 EGP
ETHYRONATE 200MG/5ML SUSP. 100 ML? different route - not eyediscontinuedUNIPHARMA CO. > UNIPHARMA9.50 EGP
ETHYRONATE 400MG/5ML SUSP. 100 ML? different route - not eyediscontinuedUNIPHARMA CO. > UNIPHARMA11.75 EGP
ACNI-CARE 2% LOTION 25 ML? different route - not eyediscontinuedSIGMA20.00 EGP

MAIN TREATMENT - choose one

3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose 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.

Cautions
  • RED FLAG - Unilateral or atypical blepharitis requires eyelid biopsy to rule out malignancy (basal cell carcinoma or sebaceous carcinoma).
4

DOXYCYCLINE

2nd line

Strength50 mg

Formoral.solid

Adult dose and duration

50-100 mg once daily orally for 4-6 weeks for severe posterior blepharitis / meibomian gland dysfunction x 4-6 weeks

Paediatric dose

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.

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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
DOXYCOST 50MG 30 TABS.PENTA PHARMA51.00 EGP (1.70/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.