Which ointment is recommended for blepharitis due to its activity on the ocular surface?

• A. Polysporin
• B. Bacitracin
• C. Neosporin
• D. Tobra/Genta

Answer: (B)

Blepharitis is commonly driven by colonization of the lid margins with gram-positive cocci, especially Staphylococcus species. The goal is to place an antibiotic on the ocular surface that stays in contact with the eyelid margin long enough to suppress these bacteria. Bacitracin ointment fits this need well because it has strong activity against gram-positive organisms, including Staph, and its ophthalmic ointment form adheres to the lid margin and persists on the ocular surface, maximizing local exposure where the inflammation sits. It also tends to be gentler on the ocular surface with limited corneal penetration, reducing toxicity risk. In contrast, products containing neomycin can provoke allergic reactions on the eyelids, and broader-spectrum combinations or aminoglycoside-only formulations target organisms or sites that are less relevant to blepharitis, making bacitracin the most appropriate choice for this scenario.