The remaining two reports evaluated oral azithromycin prescribed at a dose of 500 mg/day for 3 consecutive days repeated for 3 or 4 weekly cycles. One prospective series including 13 patients with posterior blepharitis not responding to topical antibiotics and corticosteroids found improvement in TBUT and eyelid health but not in corneal staining.
The second group treated patients with papulopustular rosacea and found no improvement in the Schirmer score, TBUT, or corneal staining, but 87% of the treated patients experienced symptomatic improvement
The potential risks associated with the antibiotics used for management of MGD include photosensitivity, gastrointestinal disturbances (emesis, diarrhea, and dyspepsia), hypersensitivity, interference with anticoagulant medications, and genitourinary symptoms, and their use can also promote microbial resistance.
“It is important to juxtapose these risks against what may be a modest benefit for patients,” Dr. Wladis said.