Azithromycin 1.5% ophthalmic solution: efficacy and treatment modalities in chronic blepharitis

Abstract

Purpose: To assess the efficacy of topical 1.5% azithromycin in the treatment of mo derate to severe chronic blepharitis and to compare the efficacy of two different treatment modalities. Methods: A randomized clinical trial included 67 patients with chronic anterior and/or posterior blepharitis, followedup for 3 months. Signs and symptoms were graded according to severity. Patients were randomized into two groups: 33 patients in group I and 34 patients in group II. Group I patients were treated with topical 1.5% azithromycin twice a day for three days, and Group II patients were treated with topical 1.5% azithromycin twice a day for three days then at bedtime for the rest of the month. All patients were instructed to apply warm compresses and an eyefriendly soap twice daily. Results: Patients in both groups tolerated the treatment with minimal irritation. A signi ficant improvement in signs and symptoms was noted at the one week fol lowup visit. Group II showed a more pronounced and longerlasting improvement that persisted after three months of followup. Conclusion: Topical 1.5% azithromycin ophthalmic solution is an effective treat ment option for chronic blepharitis. In moderate to severe blepharitis, a one month treatment is safe and shows better improvement than the threeday protocol with no significant relapse until three months of followup.

Assessment of efficacy of topical azithromycin 1.5 per cent ophthalmic solution for the treatment of meibomian gland dysfunction

“…In our study, significant improvements in the objective parameters were achieved at the first month but these improvements did not persist during the three‐month follow‐up. This finding is different from a previous study by Fadlallah and colleagues . The authors demonstrated that a one month treatment with 1.5 per cent azithromycin (twice daily for three days then once at bedtime for the rest of the month) resulted in a pronounced improvement with no significant relapse until three months.…”

“…Based on our study, significant improvements were achieved one month after topical azithromycin 1.5 per cent ophthalmic solution in all assessed parameters, including mean patient total symptom score, mean meibomian gland grading score, Schirmer test with anaesthetic, mean TFBUT and mean corneal fluorescein staining score. Our results are consistent with previously reported studies . We suppose that these improvements may be related to the anti‐inflammatory effect of azithromycin.…”

“…There were significant improvements from baseline in TFBUT, Schirmer test value and reductions in ocular surface staining, as well as improvements in lid margin scores, patient‐rated symptom scores and ocular surface disease index scores. A recent study by Fadlallah and colleagues found that treatment with azithromycin ophthalmic solution 1.5 per cent is an effective treatment option in chronic blepharitis. The authors demonstrated that twice daily for three days then once daily for a total of 30 days was more effective in improving eyelid redness/swelling and meibomian gland secretions than treatment administered twice a day for three days with moderate‐to‐severe chronic blepharitis.…”

“…Recent reports have explored the efficacy of topical azithromycin ophthalmic solution in the treatment of posterior blepharitis . Regarding the anti‐inflammatory and antibacterial effect of azithromycin, it is valuable to evaluate its efficacy in the treatment of MGD.…”

Medical management of blepharitis

“…Luchs et al [20] found that patients randomized to topical 1% azithromycin and warm compresses showed significantly less meibomian gland plugging, less eyelid margin erythema, improved meibomian gland secretion, and patients reported greater symptom relief compared with those who used warm compresses alone. Another study evaluated treatment duration of 1 month versus 3 days of topical 1.5% azithromycin and found that patients treated for 1 month had significantly less eyelid edema/erythema and MGD when evaluated at 3 months posttreatment [21].…”