Rosh Emergency Medicine Practice Test

What initial treatment should be prescribed for a patient with pink eyelid margins and crusting eyelids likely due to blepharitis?

1. Ciprofloxacin ophthalmic drops

2. Doxycycline orally

3. Erythromycin ophthalmic ointment

4. Prednisolone ophthalmic drops

The correct answer is: Erythromycin ophthalmic ointment

In cases of blepharitis, which is often characterized by inflammation of the eyelid margins leading to symptoms such as pink eyelid margins and crusting, the initial treatment typically involves the use of topical antibiotics to address any bacterial components contributing to the condition. Erythromycin ophthalmic ointment is particularly suitable for this purpose due to its efficacy against common bacteria that can exacerbate blepharitis. This antibiotic ointment can help reduce bacterial growth, alleviate symptoms of inflammation, and promote healing of the eyelid margins. It is effective in targeting and managing the conditions associated with blepharitis, allowing for symptom relief and improved eyelid hygiene. Other treatments such as oral doxycycline may be reserved for more severe cases or when there is a need to address underlying inflammation or infection. Topical antibiotics like ciprofloxacin are typically used for specific types of bacterial conjunctivitis, not for blepharitis itself. Similarly, prednisolone ophthalmic drops are corticosteroids meant to reduce inflammation but are not the first line in addressing the primary infectious cause of blepharitis. Thus, erythromycin ophthalmic ointment stands out as the appropriate choice for initial management of blepharitis, targeting the causative factors effectively and safely.