Assessment of efficacy of topical azithromycin 1.5 per cent ophthalmic solution for the treatment of meibomian gland dysfunction

Abstract

Background:The aim was to evaluate the clinical efficacy of topical azithromycin 1.5 per cent ophthalmic solution in treatment of the clinical signs and symptoms associated with meibomian gland dysfunction (MGD). Methods: In this retrospective study, 35 patients with MGD were treated with topical azithromycin 1.5 per cent ophthalmic solution for 30 days. Topical azithromycin 1.5 per cent ophthalmic solution was prescribed twice daily for two days and then once daily for a total of 30 days. Daily lid hygiene with dilute baby shampoo was instructed for all patients. Patient total symptom score, meibomian gland grading score, Schirmer score with anaesthetic, tear film break-up time (TFBUT) and corneal fluorescein staining score were evaluated at baseline and after one and three months. Results: Patient total symptom score, meibomian gland grading score, Schirmer score with anaesthetic, TFBUT and corneal staining score reduced significantly from the baseline to the first month (p < 0.05, for each); however, at the third month, there was no significant difference from baseline in the meibomian gland grading score, Schirmer score with anaesthetic, TFBUT and corneal fluorescein staining score (p > 0.05, for each).Conclusion: These results demonstrate that topical azithromycin 1.5 per cent ophthalmic solution appears effective in the short-term treatment of the clinical signs and symptoms associated with MGD.

Composition and Diversity of Bacterial Community on the Ocular Surface of Patients With Meibomian Gland Dysfunction

“…38 Azithromycin could help improve clinical signs and parameters, such as tear film break-up time, Schirmer test, and meibomian gland plugging, of patients with MGD. [39][40][41] In this study, we found conjunctival sac bacterial imbalances in patients with MGD. Overgrowth of Staphylococcus and Sphingomonas provided microbiological evidence for investigating the mechanisms of the efficacy of antibiotics in MGD.…”

“…In our study, all patients with MGD had different degrees of bacterial imbalance in the conjunctival sac, and dysbacteriosis occurred in severe cases. Because antibiotic treatment can alleviate clinical symptoms of patients with severe MGD, 18,[37][38][39][40] it can be speculated that dysbacteriosis linked closely with the disease process, despite the unclear mechanisms. However, the conditions of patients with MGD are usually complicated, and some cases overlap with other diseases, such as blepharitis and dry eye diseases.…”

Systematic review and meta-analysis of treating meibomian gland dysfunction with azithromycin

“…People who suffer from acne rosacea or seborrheic dermatitis or psoriasis are more prone to have MGD than the general population [ 3 ]. Complicated pathogenesis of the disease combined with the cutaneous conditions makes it hard to manage, while the current means of therapy are limited [ 4 ].…”

“…To achieve better therapeutic effects, combined means are always employed to treat the disease because both inflammatory and bacterial elements are involved in the development of MGD [ 5 ]. To date, eyelid hygiene, lid massage, warm compresses, artificial tears, and topical antibiotics are routine ways to treat the disease [ 4 ]. In addition, topical steroids and/or immunosuppressive agents (e.g., cyclosporine A, Cs A) have been used in some cases and gained satisfactory outcomes, but the complications from steroids and high cost of Cs A cannot be ignored for long-term use [ 6 , 7 ].…”

“…Based on these advantages, azithromycin, either topical, or oral formulations, has been employed to treat MGD in recent years. Although the efficacy of treating MGD with azithromycin has been testified in several clinical studies, contrary results were found when comparing some outcomes (e.g., tear secretion, corneal staining, and Schirmer test) among these studies [ 1 , 4 , 8 , 12 – 26 ]. In addition, comparisons of managing MGD with different azithromycin formulations and the effectiveness between azithromycin and other macrolides are still not confirmative due to the small sample sizes of the studies.…”