Antibiotics with anti-inflammatory action can reduce dry eye symptoms

Antibiotics such as Lymecycline and Azithromycin all help reduce dry eye symptoms because of their anti-inflammatory action.
There is a surprisingly large number of antibiotics that have a concomitant anti-inflammatory action which we can use as an important treatment in dry eye disease due to meibomian gland dysfunction.
The action is twofold in as much that they

• alter or reduce or alter the eyelid flora, the microbiome that is contributing to the meibomian gland dysfunction
• alter the ocular surface inflammation through their direct anti-inflammatory effect.

Full doses do not have to be taken and small doses can be used for a longer period of time.
The two main groups of antibiotics that we use are tetracyclines and macrolides. Oral Doxycycline, Minocycline or Lymecycline successfully improve can improve symptoms and signs of meibomian gland dysfunction. However, there are some potential gastrointestinal side-effects.
There is also some concern about whether they will affect the gut microbiome. For instance, it is not totally clear what long-term effect Doxycycline or Lymecycline have on altering the gut flora and how therefore the gut microbiome may modulate the body’s immune system.
An alternative is to use Azithromycin either topically or orally or both. There was a comparison study of topical Azithromycin versus oral Doxycycline which showed that both improved signs and symptoms of meibomian gland dysfunction, but with different compositions of changes in meibom suggesting their very different mechanisms of action.
Unlike Doxycycline, Azithromycin stimulates meibomian gland cell differentiation. A five day course of Azithromycin may be sufficient but has been used clinically up to two weeks.
In the next blog post, I am going to talk more about Meibomian gland, heating and expression.