Efficacy and safety of topical azithromycin therapy in patients with blepharitis and meibomian gland dysfunction

Abstract

Purpose: To assess the effects of 1% azithromycin ophthalmic solution (AZM) in patients with bacterial blepharitis accompanied by meibomian gland dysfunction (MGD).

Study design: A multicenter, single arm, prospective interventional study.

Methods: AZM was administered to the affected eyes twice daily for the first 2 days and once daily for the subsequent 12 days. Lid margin hyperaemia/redness, collarette at the root of the eyelashes, conjunctival hyperaemia, foreign body sensation, and epiphora were assessed on Days 1, 14, and 28. The Dry Eye-related Quality of Life Score (DEQS) and objectives related to MGD, including lid vascularity, lid margin irregularity, foaming, lid plugging, keratoconjunctival disorders, Marx line, meibum grade, and tear breakup time, were also assessed. Bacterial culture of the conjunctival sac and meibum was performed on Days 1 and 14.

Results: Twenty-four eyes of 24 patients (10 men/14 women, mean age 72.3 ± 13.2) were included. On Days 14 and 28, the total score, lid vascularity, lid plugging, and meibum grade showed significant improvement (p < 0.05). On Day 1, 71 strains were isolated from 22 of the 24 eyes (91.7%). Cutibacterium acnes, Corynebacterium spp., and Staphylococci were detected at high frequencies. The overall disappearance rates of the bacteria in the conjunctival sac and meibum at the end of treatment were 65.7% and 58.3%, respectively. No serious ocular or systemic adverse events were observed.

Conclusion: Fourteen-day treatment with AZM was effective in patients with blepharitis accompanied by MGD, and the efficacy of AZM persisted for a period after the treatment.

Keywords: Azithromycin; Bacteria; Blepharitis; Eyelid; Meibomian gland dysfunction (MGD).

Fig. 1

Subject disposition

Fig. 2

(a) Changes in the total scores of blepharitis from baseline. (b) Changes in the total objective and subjective scores of blepharitis from baseline. p-values of Days 14 and 28 compared with those at baseline were obtained using the Wilcoxon signed-rank test (* p < 0.01). The bars indicate the SD. SD, standard deviation

Fig. 3

Changes in (a) lid vascularity, (b) lid margin irregularity, (c) foaming, (d) lid plugging, (e) conjunctival FS score, (f) corneal FS score, (g) Marx line, (h) meibum grade, and (i) tear break-up time from baseline p-values of Days 14 and 28 compared with those at baseline were obtained using the Wilcoxon signed-rank test (*: p < 0.05, **: p < 0.01). The bars indicate the SD. FS, fluorescein staining; SD, standard deviation

Fig. 4

Change in DEQS from baseline. p-values of Days 14 and 28 compared with those at baseline were obtained using the Wilcoxon signed-rank test (*: p < 0.01). The bars indicate the SD. DEQS, Dry Eye related Quality of life Score; SD, standard deviation

Fig. 5

Distribution of the MIC of azithromycin for all strains on Days 1 and 14 shown as a cumulative curve in the (a) conjunctival sac and (b) meibum. MIC, minimum inhibitory concentration