Studies investigating oral antibiotics for management of meibomian gland dysfunction (MGD) have shown their use provides some benefit. Research on this topic is limited, however, and oral antibiotic treatment is not free of risk, reported Edward J. Wladis, MD.
“I tend to reach for oral antibiotics to manage MGD that is refractory to other treatments, but it is incredibly important to have a very frank discussion with patients about the benefits that can be expected and the risks,” said Dr. Wladis, associate professor, Department of Ophthalmology, Albany Medical Center, Albany, NY. “I am hoping in the future to see well-designed studies that will provide a clearer roadmap of the indications for using antibiotics in this frustrating clinical setting.”
The oral antibiotics used often to treat MGD include tetracyclines—doxycycline, tetracycline, and minocycline—along with azithromycin. Dr. Wladis said there is good biologic plausibility to suggest that these agents should be effective considering their multimodal mechanisms of action.
First, they all are antimicrobials, and it is known that patients with MGD associated with rosacea have increased skin colonization with Demodex. In addition, all of those medications inhibit nitric oxide, which is a potent vasodilator that contributes to telangiectatic blood vessel formation. They also have anti-inflammatory properties mediated by suppression of B cell activation and inhibition of interleukin-1.