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Flavio Mantelli, Antonio Di Zazzo, Caterina Dianzani, Alessandro Lambiase, Stefano Bonini; Topical Azythromicin In The Treatment Of Ocular Rosacea. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1500.
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Acne rosacea is one of the most common dermatological conditions, with approximately 14 million Americans affected. Chronic posterior blepharitis, recurrent meibomian cysts and marginal superficial keratitis are common findings in patients with rosacea, and are often referred to as ocular rosacea. Well-accepted treatments for this condition include lid hygiene and long-term low-dose systemic doxicycline, which is known to reduce both meibomian gland inflammation and eyelid bacterial flora in patients with rosacea. Low-dose doxycycline does not lead to the development of antibiotic-resistance, and is proven to have anti-inflammatory properties and ameliorate meibomian gland secretion. Recent reports on the anti-inflammatory properties of azythromicin suggest it could become an additional therapeutic option for ocular rosacea.
In this study we restrospectivally evaluated ocular signs and symptoms, lacrimal function and meibomian gland clogging of 37 patients with acne rosacea. Severity of their ocular involvement was assessed using the OSDI score. Twelve patients with moderate-to-severe blepharitis were treated with systemic doxicycline 100mg/die for one month; 16 patients with moderate-to-severe blepharitis were treated with preservative-free azythromicin eye drops (Azyter®) bid for 6 days; 9 patients with mild-to-moderate blepharitis were treated with preservative-free artificial tears 6 times daily for one month. All patients also performed lid hygiene bid for the entire month.
At one month of follow-up a significant reduction in burning, tearing, hyperemia, secretion, foreign body sensation and visual symptoms was reported by all patients (p<0.05). A significant improvement in tear film break-up time, meibomian gland clogging, and superficial punctate keratitis was also observed in all patients (p<0.05). All treatments were well tolerated by the patients, with mild gastro-intestinal symptoms in the systemic doxicycline group and mild burning after instillation in the azythromicin group being the only side-effects reported.
Systemic doxicycline and topical azythromicin were safe and effective treatments for improving ocular signs and symptoms of acne rosacea. The main advantage of topical therapy with azythromicin eye drops is related to the shorter duration of treatment as compared to systemic treatment with doxicicline, which may result in higher compliance to therapy.
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