Azithromycin is an antibiotic that has been safely used for some time to treat conjunctivitis. It is only in recent times that it has been found to be useful for dry eyes. We find it particularly useful to treat red, inflamed lids with thickened secretions.
Unlike most antibiotics azithromycin has powerful anti-inflammatory properties. When treating meibomian gland dysfunction (MGD) use of anti-inflammatories such as steroids is a very common and successful treatment option. However, steroids have to be used carefully due to the risk of increased pressure in the eyes (steroid response) and may only be used for short periods of time.
In MGD there is inflammation in the glands. Reducing this inflammation allows the glands to function more normally and the thickened secretions in the glands start to thin out.
The advantage of azithromycin is that it is reducing the bacterial load as well as having anti-inflammatory properties. It targets different inflammatory pathways to steroids and doesn’t have the same risk of raising the intraocular pressure.
Azithromycin can be used in the eye as a drop or ointment. It is readily available in the US as Azasite (1% azithromycin) and has FDA approval to be used for up to one month at a time. It isn’t readily available here in Perth but we have it made up at a local compounding pharmacy. There is stinging on application but that soon passes.
Oral antibiotics such as doxycycline can be used to help in the treatment of MGD in much the same way as they are prescribed for acne or rosacea. Often they are used for a few months at a time. They can be very effective but side effects such as upset stomachs are not uncommon. Recently oral azithromycin has been used and it seems that the same results can be achieved when taking the medication for much shorter times. However, further research needs to be done in this area.