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Topical azithromycin restores normal lipid quality in meibomian gland secretions
Cornea. 2010;29:781-788.
Topical azithromycin improved symptoms of meibomian gland dysfunction and restored the normal ordering of lipid molecules in gland secretions, according to a study.
"The identified changes in the lipids help to explain some of the abnormalities of tear film function in evaporative dry eye," the study authors said. "Topical therapy with azithromycin relieved signs and symptoms and restored the lipid properties of the meibomian gland secretion toward normal."
The prospective clinical trial included 22 patients with symptomatic meibomian gland dysfunction who did not respond to lid massage. Five patients did not complete the 4 weeks of therapy.
Investigators evaluated conjunctival injection, tear break-up time, ocular surface, eyelid margins and meibomian gland orifices. A questionnaire was used to measure subjective symptoms of meibomian gland dysfunction such as itching, burning, foreign body sensation, eyelid redness and eyelid swelling.
All patients were treated with 1% topical azithromycin ophthalmic solution (Azasite, Inspire Pharmaceuticals). Patients were instructed to use one drop twice daily for 2 days, then one drop daily for 4 weeks.
Study data showed significant patient-reported responses to therapy at 2 weeks and 4 weeks; symptom severity showed statistically significant decreases at 4 weeks (P < .001).
At 4 weeks, the authors noted improvements in the number of obstructed glands, amount of lid margin erythema, ease of meibomian gland expression and quality of meibomian gland secretion.
In addition, improvement in tear breakup time was statistically significant at 4 weeks (P < .001).
Meibomian gland dysfunction is one of the most common clinical findings presenting to ophthalmologists on a regular basis. In addition to contributing to erythema and a burning sensation, meibomian gland dysfunction impacts directly on the pre-corneal tear film and directly affects quality of vision. This article provides strong evidence for the efficacy of topical azithromycin for the treatment of meibomian gland dysfunction. Azithromycin has a remarkable ability to penetrate into tissue. This article by Foulks et al demonstrates the efficacy of daily topical azithromycin to improve lipid stability and melting temperature with the expected improvement in patient’s signs and symptoms. Topical azithromycin is an effective and welcome addition in the management of this important clinical condition.
– Eric D. Donnenfeld, MD
OSN
Cornea/External Disease Board Member
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