The effect of azithromycin eye drops or oral doxycycline on tear film thickness in patients with Meibomian gland dysfunction

Abstract

Purpose : Meibomian gland dysfunction (MGD) is a common condition of the eyelids leading to tear film instability and resulting in dry eye disease or ocular surface disease (OSD). Oral doxycycline has been used for a long time for the treatment of MGD but is associated with systemic side effects. Topical azithromycin has therefore been proposed as a valuable alternative to systemic antibiotic treatment. The present study set out to compare the effect of topical azithromycin with oral doxycycline on tear film thickness (TFT) in patients with MGD.

Methods : Twenty patients with MGD were included in this observer-masked, parallel-group study and were randomized to either receive topical azithromycin for 4 weeks or oral doxycycline for 6 weeks. Main outcome of the study was the change in TFT as measured with ultra-high resolution optical coherence tomography before and 6 weeks after treatment start.

Results : Six weeks after treatment initiation, TFT increased from 5.0 ± 1.0 to 5.5 ± 1.1 µm (11.5 ± 30%) in the azithromycin group and from 4.7 ± 0.9 to 5.6 ± 1.1 µm (21.0 ± 28.6%) in the doxycycline group (p = 0.028 over time) with no difference between the two groups (p = 0.267). Systemic Adverse Events (AEs) occurred more frequently in the doxycycline group, while eye-related AEs were more common in the azithromycin group.

Conclusions : The present study found that topical azithromycin as well as systemic doxycycline improves TFT in patients with MGD with no difference between the two treatments. Due to the higher occurrence of systemic side effects when taking doxycycline, azithromycin eye drops seem to be an alternative with comparable efficacy.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.