# Blepharitis > Blepharitis for FMGE Ophthalmology: anterior staphylococcal and seborrhoeic types, posterior Meibomian gland dysfunction, marginal keratitis and treatment. - Canonical URL: https://prepelephant.com/topics/fmge/ophthalmology/blepharitis-fmge - Exam / course: FMGE · Subject: Ophthalmology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Blepharitis", PrepElephant, https://prepelephant.com/topics/fmge/ophthalmology/blepharitis-fmge ## Direct answer Burning, grittiness and crusted lids that feel worst on waking, recurring for years in an adult, define blepharitis — chronic inflammation of the lid margin. Anterior blepharitis involves the lash side of the margin: staphylococcal disease with hard crusted collarettes around lash bases, sometimes with lash loss and ulceration, and seborrhoeic disease with greasy scales riding on a hyperaemic margin. Posterior blepharitis is Meibomian gland dysfunction, with plugged gland orifices, telangiectatic vessels, foam in the tear lake and a poor tear film — the form most responsible for chronic irritation and for feeding chalazia. Management is a regimen, not a prescription: warm compresses, lid hygiene and massage, topical antibiotic ointment, with oral doxycycline (or azithromycin where doxycycline is contraindicated) for posterior disease and ocular rosacea. ## What you must remember - Anterior staphylococcal blepharitis: hard crusting and collarettes at lash bases, chronic conjunctivitis, sometimes marginal keratitis; complications include trichiasis, madarosis, and styes and chalazia. Seborrhoeic blepharitis adds greasy, yellowish scales on an unulcerated margin with scalp and brow dermatitis. - Posterior blepharitis (Meibomian gland dysfunction): pouting, plugged orifices, thickened secretions, foam in the tear meniscus, telangiectasia of the posterior margin, and evaporative dry eye. - Symptoms characteristically worse in the morning (overnight accumulation of debris and inflammation), distinguishing them from aqueous-deficient dry eye, which worsens through the day's screen use. - Marginal catarrhal keratitis — infiltrates or small ulcers 2 to 3 mm inside the limbus — is a staphylococcal toxin-mediated complication treated with a short course of combined steroid-antibiotic drops. - The treatment triad: warm compresses to melt secretions, lid margin scrubbing, and gland expression or massage; consistency matters more than any drug. - Oral doxycycline 100 mg daily (low-dose, for its anti-collagenase and anti-inflammatory action) for posterior blepharitis and ocular rosacea — avoid in children under eight and in pregnancy, where azithromycin or erythromycin substitutes. - Associated conditions to look for: rosacea (rhinophyma, facial flushing), seborrhoeic dermatitis, and dry eye; chalazion and hordeolum recurrence is the commonest presenting complication. - Blepharitis is chronic and relapsing — the consultation sets expectations for long-term lid hygiene rather than a cure. ## Working through a chronic lid margin A 45-year-old shopkeeper describes five years of bilateral burning and grittiness, worst in the mornings, with recurring "styes" and crusted lashes he picks off each day. Slit-lamp examination reads the lid margin like a document. Along the lash line sit hard collarettes clinging to lash bases with two lashes turning in — anterior staphylococcal disease. Posteriorly, the Meibomian orifices are pouting and plugged, the margin vessels are telangiectatic, and foam floats in the tear lake; express a gland and a turbid, toothpaste-like secretion emerges — posterior blepharitis with Meibomian dysfunction. Fluorescein shows a fragmented tear film with rapid break-up, and 3 mm inside the inferior limbus sits a quiet grey infiltrate — marginal keratitis, the complication that explains his worst weeks. Build the regimen in order: warm compresses twice daily for five minutes to melt the secretions, lid scrubbing with diluted baby shampoo or a commercial lid wipe along the margin, and massage to express the glands; add erythromycin ointment to the lash bases at night for the anterior component, and a short combined steroid-antibiotic course for the marginal infiltrate while it is active. Because his posterior disease is severe and his cheeks flush easily, start low-dose doxycycline for six to eight weeks and counsel that this is a regimen for months, not a prescription for a week — the single most common reason treatment "fails" is that it stops. ## Where candidates slip Candidates prescribe antibiotic drops and stop — drops alone barely touch a disease of the lid margin and glands, and the marks sit with compresses, scrubs and expression. The second slip is the doxycycline detail: the dose is low and the purpose anti-inflammatory, not antimicrobial, and it is contraindicated in children and pregnancy. The third is misreading the morning-worse history as simple dry eye; the foam, the plugged orifices and the recurrent chalazia identify evaporative dysfunction from blepharitis, which changes both counselling and therapy. ## Frequently asked questions ### How are anterior and posterior blepharitis distinguished? Anterior disease affects the lash margin — staphylococcal crusting and collarettes or greasy seborrhoeic scales; posterior disease involves Meibomian glands, with plugged orifices, telangiectasia and foam in the tears. ### What is marginal catarrhal keratitis? Sterile infiltrates or shallow ulcers 2 to 3 mm inside the limbus from staphylococcal toxin hypersensitivity in anterior blepharitis, treated with short steroid-antibiotic drops. ### Why is oral doxycycline used in posterior blepharitis? For its anti-inflammatory and anti-collagenase effects on Meibomian dysfunction at low dose, typically 100 mg daily for weeks; alternatives are azithromycin or erythromycin when doxycycline is contraindicated. ### Which lid-hygiene steps form first-line treatment? Warm compresses to melt gland secretions, followed by lid margin scrubbing and massage or expression, performed twice daily long term. ### What complications follow untreated blepharitis? Recurrent styes and chalazia, trichiasis and madarosis, chronic conjunctivitis, marginal keratitis, and evaporative dry eye. ### Why do blepharitis symptoms worsen in the morning? Because secretions, debris and inflammatory mediators accumulate overnight with the lids closed, whereas aqueous-deficient dry eye typically worsens with evening screen use.