Azithromycin in DuraSite for the treatment of blepharitis

Abstract

Blepharitis is a common inflammatory disease of the eyelid. Posterior blepharitis affects the posterior lamella of the eyelid and involves inflammation of the meibomian glands, whereas anterior blepharitis affects the anterior lamella of the eyelid and the eyelashes; either version can be inflammatory or infectious in nature. Each of these conditions can incite or propagate the other; anterior blepharitis, if not treated, can lead to meibomian gland disease, and vice versa. Blepharitis is typically chronic, and can be associated with a variety of systemic diseases such as dermatitis, as well as ocular diseases such as dry eye, conjunctivitis, or keratitis. The standard treatment regimen historically consists of lid hygiene with warm compresses and eyelid scrubs, although these treatment modalities may have limited efficacy for many patients, especially those with more severe disease. Adjunctive treatment includes systemic and topical antibiotics, topical corticosteroids, and tear replacement therapy. Topical antibiotics are recommended to decrease the bacterial load, and topical corticosteroids may help in cases of severe inflammation. Azithromycin ophthalmic solution 1% in DuraSite((R)) (AzaSite((R)); Inspire Pharmaceuticals, Durham, North Carolina, USA) has been proposed as a novel treatment for posterior blepharitis, based on its well-known anti-infective profile, its anti-inflammatory properties, its excellent tissue penetration, and its regulatory approval for the treatment of bacterial conjunctivitis. This review focuses on an off-label indication for topical azithromycin 1% in DuraSite for the treatment of blepharitis.

Keywords: lid margin disease; meibomian gland disease.

Figure 1

Effects of topical azithromycin in combination with warm compresses, compared with warm compress-only group on lid redness. Note: The clinical signs were rated by the investigator as 0 = normal, 1 = mild, 2 = moderate, 3 = severe, and 4 = very severe.

Figure 2

Effects of topical azithromycin in combination with warm compresses, compared with warm compress-only group on meibomian gland plugging. Note: The clinical signs were rated by the investigator as 0 = normal, 1 = mild, 2 = moderate, 3 = severe, and 4 = very severe.

Figure 3

Effects of topical azithromycin in combination with warm compresses, compared with warm compress-only group on quality of meibomian gland secretion. Note: The clinical signs were rated by the investigator as 0 = normal, 1 = mild, 2 = moderate, 3 = severe, and 4 = obstructed.