Dry Eye Management With Antibiotics Yields Unknown Long-Term Effects

Patients with blepharitis or meibomian gland dysfunction (MGD)-related dry eye disease (DED) frequently experience a short-term resolution of signs and symptoms with antibiotic treatment, according to a study published in Ocular Surface. However, these improvements often revert following discontinuation of treatment, creating mild adverse effects and the need for further treatments. 

Researchers evaluated studies from a review of the literature that addressed topical and systemic antibiotic therapy in the management of DED due to MGD or blepharitis. The search terms ‘antibiotics OR azithromycin OR doxycycline OR minocycline AND dry eye disease OR meibomian gland OR blepharitis anterior OR blepharitis posterior OR chronic blepharitis’ resulted in a return of 619 studies. After applying inclusion criteria, 22 studies which included randomized controlled trials (RCTs; n=12), non-randomized prospective studies (n=9), and a retrospective study (n=1) were included in the final analysis. The studies were published between April 2003 and January 2021 and spanned 12 countries. 

Overall, many of the investigations revealed that azithromycin, doxycycline and minocycline were common oral antibiotics with common treatment durations of 5 days, 1 month, and 3 months, respectively. Topical azithromycin was also commonly used, most often for a period of 4 weeks. The research team evaluated the effects of these drugs on various ocular surface parameters. 

According to the report, oral doxycycline improved tear breakup time (TBUT) in 4 of 5 studies, Schirmer test results in 1 of 2 studies, ocular surface staining (OSS) in 5 of 5 studies and conjunctival redness or hyperemia in 4 of 4 studies. Oral azithromycin improved TBUT in 3 of 4 studies, OSS in 2 of 5 studies and conjunctival redness or hyperemia in 2 of 2 studies. Topical azithromycin improved TBUT in 5 of 6 studies, Schrimer score in 2 of 4 studies, OSS in 4 of 6 studies and conjunctival redness or hyperemia in 4 of 4 studies. 

A total of 4 studies evaluated minocycline treatment. Two of 2 studies reported improvements in TBUT and lid margin abnormality, but mixed results were reported for other ocular surface parameters. 

Overall, investigators report oral and topical antibiotics appear to have positive short-term effects on the signs and symptoms of blepharitis-or MGD-related DED. However, these improvements often revert upon ending treatment and patients may need to repeat treatments and contend with mild adverse events.

“Current evidence suggests that topical and oral antibiotic use in managing DED related to MGD or blepharitis yields short-term improvement in signs and symptoms, but the long-term effects are still unclear,” according to the researchers. “Given the large number of patients suffering from these conditions, and the rising problem of antibiotic resistant bacteria, the role of antibiotic use in DED management and the potential harm of overuse of antibiotics in the long-term should be carefully considered, particularly given the availability of other purely anti-inflammatory or non-medicinal alternative treatments.”

Study limitations include a short follow-up period, variations in symptom scoring across studies, uncontrolled use of adjuvant treatments, unknown patient compliance, and differences in study duration, design, and grading systems.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or clinical research organizations. Please see the original reference for a full list of authors’ disclosures.