Oral doxycycline and topical azithromycin shows stabilization of tear film in Meibomian gland dysfunction
Ocular surface disease (OSD) is a multifactorial and a highly frequent problem which may lead to pain, inflammation, irritation, photophobia, blurred vision, and vision loss. There are many essential causes of OSD such as inadequate or unstable tear film and neurotrophic keratopathy (NK) which is a degenerative corneal disorder that affects the health and integrity of the ocular surface secondary to impairment of corneal nerves that alters their trophic and sensory function. Also, meibomian gland dysfunction (MGD) incidence varies widely based on ethnicity, sex, and age. MGD also has a significant influence on the patients’ life quality, as it is frequently a contributing factor to evaporative dry eye and is responsible for symptoms of irritation of the eyelid and ocular surface. Risk factors of MGD include aging, deficiency of sex hormones specially androgens, other systemic diseases such as Stevens–Johnson syndrome (SJS), atopy, Sjogren’s syndrome (SS), psoriasis, and hypertension. Also, ophthalmic disorders such as chronic blepharitis, contact lens wear, and trachoma may play a role.
MGD pathophysiology is caused by obstruction of meibomian gland and hyper-keratinization of the epithelium of the meibomian duct which results in decreased meibum availability over the tear film aqueous layer. Reduced meibum leads to elevation of bacterial growth on the margin of the lid, instability of the tear film, increased hyperosmolarity, and tears evaporation. MGD choices of treatment vary from initial conservative interventions involving eyelid massage, eyelid expression, and warm compression to, in more severe cases, medical intervention with anti-inflammatory drugs. In past trials, antibiotics such as doxycycline and azithromycin were proven to effectively treat both the signs and symptoms of MGD patients.
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