Could two new off-label treatments be used used to treat blepharitis and MGD?

[hannsho]

I have for many years suffered from chronic posterior blepharitis, meibomitis and associated evaporative dry eye and have read extensively on this subject. I have been using Restasis for the past 7 months which has helped with recurring ocular hyperemia, but given that this medicine is rather expensive, I have been looking for possible alternatives to treat my condition. Putting together information from diverse sources I found something rather surprising.

1. Meibomian duct probing has been found to be effective in treating chronic blepharitis and MGD in a number of clinical studies.

2. Topic Azithromycin eye drops 1% (Azasite) has also be found to be effective for treating posterior blepharitis and MGD. It has excellent anti-inflammatory properties and helps to restore the fluidity of meibomian gland secretions.

3. Some Ophthalmologists have prescribed Azithromicin eye drops for maintenance purposes on a pulsed basis, for example 1 drop per day for 7 days repeated at the beginning of each month in order to prevent possible flare-ups of blepharitis. At least one study has suggested that this form of maintenance treatment is worth investigating.

My suggestion then is could these two treatments - initial probing of the meibomian glands, followed by Azithromycin drops for maintenances purposes used in a pulsed dosage regime - be combined as a possible effective way of treating posterior blepharitis / ocular rosacea / meibomitis and associated dry eye?

There is the possibility of Azithromycin creating bacterial resistance (though in clinical trials it has been used continually for at least one month with no side effects).

Given the limited options available for treating theses chronic conditions, I believe this subject is worth discussing and I would appreciate very much any comments, particularly on the possibility of Azithromycin creating bacterial resistance when used in a long-term, pulsed, treatment regime. It is also worth mentioning that Azithromycin 1.5% eye drops, sold under the brand name AZIDROP in Spain, costs only about US $8.00 for 6 vials - more than would be needed for the pulsed treatment of none month. I can provide some links to the studies mentioned.

Thank you for reading this post.

[farmgirl]

Interesting that you mention the possibility of using the Azithromycin as a prophylactic drop. I usually keep some antibiotic drops with me to address any eye issues that might come up when I am not in a position to obtain preservative free drops. I have used them on a couple of occasions when I get a flare up and am not just sure of where it is heading. I always find that the eye (because sometimes I only treat one) feels ever so much better after using the drops 3x/day for 7 days. I have often wondered if I could maintain that using just one drop per day but am afraid of antibiotic resistance. The idea to use it for a week or even 5 days once a month seems like a good option. I think I might ask my doc next appointment see what he says....hm-m-m-m

[hannsho]

Hi Farmgirl,

Thanks for your contribution. Although I don't know your eye problem, I suspect there would be lots of people who might benefit from the powerful-anti inflammatory property of azithromycin eyedrops used preventively in a pulsed dosage regime.

[hannsho]

Farmgirl,

I've now seen your intro and discovered that we suffer from very similar eye conditions, although my eye condition - posterior blepharitis, meibomitis, keratitis and dry eye - does not affect me as badly as it seems to affect you.

If you do consult your doctor about using antibiotic drops preventively, I would be grateful if you could tell me what he has to say. Here is something that might give you some hope. Some 25 years ago, during a period of about 2 years, I had one episode of recalcitrant blepharitis after another. I saw many doctors and ophthalmologists and thought my eye (only one eye was affected) would never be cured. But then all of a sudden it stopped. The only change I had made was to engage in a daily routine of eye hygiene. Now it has started again but I am also much older (77) and probably more susceptible to eye problems. I mention this, because it seems these problems can suddenly appear but also mysteriously suddenly disappear! At any rate I wish you luck.

[MGD1701]

these might be more effective or safer approach.
BlephEx
lid cleanser with pure HOCL, like Avenova, to control bacterial overgrow

Good luck!

[Hokucat]

Hi hannsho. Some doctors already do probing followed by azithromycin as maintenance. In fact, I had that treatment combo (as well as other steroid drops and antibiotic drops/oral tablets after probing) several years ago, as I had severe MGD and blepharitis, with many of my glands blocked by scar tissue. I had probing six different times, and each time it worked to unblock my glands, but neither the azithromycin nor any other steroid or antibiotic they gave me after the probings could keep my glands from quickly getting blocked up again. That doesn't mean these won't work for you or others. But I think you are absolutely right that something else is needed to maintain the glands functionality, after a procedure like probing unblocks the glands.

For me, a diet that includes antibacterial, antioxidant, and anti-inflammatory properties and limiting sugar, dairy, and gluten is what ultimately helped my meibomian glands better function and not get blocked again, after my last probing.

If you do try azithromycin or any other steroid or antibiotic drop, try to avoid any drops with the preservative benzalkonium chloride (BAK). BAK can cause or further exasperate dry eyes. Instead ask for preservative-free drops, which usually cost more, but are worth it. I know farmgirl is also an advocate of avoiding BAK.

I would only recommend probing if something less invasive like IPL, gland expression, Lipiflow, etc. have not worked, or if you know your glands have scar tissue. Probing is quite an invasive and uncomfortable procedure....yeah, I had it six times, and it was not fun!

[hannsho]

Hi Hokucat.

Thank you for this information. It is interesting to know that some doctors already use meibomian gland probing followed by azithromycin eyedrops for maintenance. I totally agree with you that it is best to avoid eyedrops containing BAK preservatives. Although I use Omega 3 as a food supplement, I was not aware that it is advisable to avoid sugar - and that's not good news since I rather like a sweet cake every now and then!

I'm glad t hear that you found that making changes in your diet helped to improve the functioning of your meibomian glands, that's an aspect of treatment that deserves attention.

[Sisyphus]

Yes, another example of an eye medication with BAK, prescribed by the eye care community, that can help you in the short term, but screw you in the long term.

[ishank_b]

My doctor has prescribed me NS AID to treat eye strain. I used it for 2 weeks or maybe 20 days total. Now I notice mild dry eyes almost all day and dry eyes in the morning. I am not sure if its CVS (computer vision syndrome) or BAK induced dryness. My doctor has discontinued the medicine. Now I only use tear drops these days.

Do you think this Ns Aid 0.1% Eye Drop (diclofenac sodium ophthalmic solution which also has BAK as the preservative) has induced this dry eyes feeling? If yes, how long this feeling going to last after I discontinue the drops?