Did Azithromycin eyedrops help you?

[Alix]

deep_dry_eye Alix
do either of you know if I can use normal hyloforte eyedrops whilst using azithromycin? I don’t want to wash away the effect with hylo if it will affect it negatively. I was never told if I could or not.

Hi I didn’t use any other eye drops while I was using Azyter. I was never told either whether I could or not but logically it probably isn’t the best idea, you need to give it a proper chance to work and using anything else on top of that may cause further inflammation or at least dilute its efficacy....

[Topher3]

Topher3

I used azithromycin ointment in the past and I am using it now. I think ointments are better in terms of drug delivery because they stay on your eyes for long enough so that the drug penetrates your tissues and gets absorbed significantly. Azithromycin has very good penetration and retention properties. It will bring down your inflammation quickly and deactivate bacterial esterases and lipases so that your lipids don't become thick or pasty. I remember you said your problem is low quantity of secretions so meibum consistency is not an issue. If you have access to loteprednol I would suggest you to use loteprednol ointment in combination with azithromycin ointment at night for 7 days followed by azithromycin ointment for at least 4 weeks. You can take 20mg or 50mg doxycycline orally to further suppress the proliferation of inflammatory mediators systemically. Hope it will bring your existing glands back to functionality in some months. Use MCGs religiously and avoid dessicating environments to prevent inflammation from tear hyperosmolarity.

Thanks for the information, how long would it take for the anti inflammatory effects to take place. Currently my inner eyelids are probably technically more red with using the azithromycin. I’ve used it only two times so far so maybe it has a ramp up time or something as the inner eyelid is not pink like I expected it to be. Hrmmmmmm...

[Milo007]

Thanks for the information, how long would it take for the anti inflammatory effects to take place. Currently my inner eyelids are probably technically more red with using the azithromycin. I’ve used it only two times so far so maybe it has a ramp up time or something as the inner eyelid is not pink like I expected it to be. Hrmmmmmm...

You might notice some intial aggravation in the signs of inflammation. This is because azithromycin is slightly irritating to the mucous membranes and anything put on priorly inflamed eyes could be irritating as a foreign body due to the heightened local immune response of the body by virtue of chronic inflammation itself. So it might take at least two weeks to notice any significant improvement in the degree of inflammation since the suppression of existing inflammatory processes and eradication of the existing inflammatory molecules take time. Short term steroids can expedite the process by working in a different mechanism.

Whatever the results keep using it for at least 4 weeks.

[Giacomo]

I suffer from both OSD and Blepharitis. Since I live in europe, I don’t have access to reasonably priced Restasis (via Medicare). But my question in this forum pertains to azithromyzin. In italy, I can get reasonably priced Azyter which is packaged in 6 monodose vials. My question is simply: to correct/control Blepharitis, is this applied to eyelid/eyelash area twice a day or directly as drops to the eye itself. It is quite viscous, not liquid as in a solution, but it isnt as viscous as a gel. I would prefer a topical approach to the eyelid area. I have searched the web and cannot find an answer to this. Most studies aboout Azasite and Azyter aren’t specific but seem to use drops to the eye. Am grateful to contributors for any knowledge on this or where I can go to get an answer.

[deep_dry_eye]

I suffer from both OSD and Blepharitis. Since I live in europe, I don’t have access to reasonably priced Restasis (via Medicare). But my question in this forum pertains to azithromyzin. In italy, I can get reasonably priced Azyter which is packaged in 6 monodose vials. My question is simply: to correct/control Blepharitis, is this applied to eyelid/eyelash area twice a day or directly as drops to the eye itself. It is quite viscous, not liquid as in a solution, but it isnt as viscous as a gel. I would prefer a topical approach to the eyelid area. I have searched the web and cannot find an answer to this. Most studies aboout Azasite and Azyter aren’t specific but seem to use drops to the eye. Am grateful to contributors for any knowledge on this or where I can go to get an answer.

I just dropped it inside the eyelids. Twice a day is too much, I wouldn't go beyond once a day after loading dose. azithromyzin has a very long half-life (68 hours), so assuming good penetration, you can probably get away with once every 3 days as well.

[Milo007]

I suffer from both OSD and Blepharitis. Since I live in europe, I don’t have access to reasonably priced Restasis (via Medicare). But my question in this forum pertains to azithromyzin. In italy, I can get reasonably priced Azyter which is packaged in 6 monodose vials. My question is simply: to correct/control Blepharitis, is this applied to eyelid/eyelash area twice a day or directly as drops to the eye itself. It is quite viscous, not liquid as in a solution, but it isnt as viscous as a gel. I would prefer a topical approach to the eyelid area. I have searched the web and cannot find an answer to this. Most studies aboout Azasite and Azyter aren’t specific but seem to use drops to the eye. Am grateful to contributors for any knowledge on this or where I can go to get an answer.

The ideal way of applying azithromycin formulations is to both put it inside the eyes and rub a little over closed eyelids along the eyelashes and massage gently. Massaging azithromycin formulations over the eyelashes makes sure that the drug reaches the inside of the eyelash follicles (where both inflammation and bacteria might be present) and also the drug slowly reaches the meibomian gland orifices land in the lid margins which is located millimeters away from the eyelashes.

So I would advice you to put a two drops inside your eyes and apply the remaining solution in the single use container over closed eyelids massaging it gently. Make sure you use clean fingers and it's advisable to use HOCL over the eyelids to disinfect the surface before you massage the remaining solution since some will get inside your eye and you wouldn't want to risk an infection.

[Giacomo]

Thank you both very much Milo, yours is the very first and only direction I have seen in this regard
Do you know of any other topical ophthalmic Azithromycin solutions?

[deep_dry_eye]

Thank you both very much Milo, yours is the very first and only direction I have seen in this regard
Do you know of any other topical ophthalmic Azithromycin solutions?

AzaSite is available in the US, but has preservatives. Azyter is available in the EU and certain Asian countries. You can probably get it compounded easily in other countries, but the problem is the delivery vehicle may not be as effective.

[Milo007]

Thank you both very much Milo, yours is the very first and only direction I have seen in this regard
Do you know of any other topical ophthalmic Azithromycin solutions?

Well I am from India and I have access to both azithromycin ointment and eye drops. But depending upon your location you may find the delivery vehicle of your choice. I always prefer ointments at night and gels/suspensions in daytime. It's very difficult to obtain preservative free formulations of a drug unless you trust a reputed compounding pharmacy. So you have no option other than to use it for a short term or in short bursts.

May I know where are you located?

[Giacomo]

I live in Italy, Milo. To both you and Deep Dry Eye, I see you both are on a long term azithromyin treatment for dry eye, or OSD as Dr Hagan on Medhelp says it is called now. Don’t you have concerns about using azithromycin long term because of how long it is retained, causing bacterial resistance? I am thinking of using it only for 3 days on the eye lids/ lashes and then going to a readily available inexpensive HOCL wipes or spray, either Natrasan , or Heyedrate, or OcuSoft HypoClor Plus (all three much talked about on this web site). For the OSD part of treatment, I don’t see inexpensive non-antibiotic options. I could get Restasis back in the US, partially covered by Medicare,

Do either of you, who have been at this “game” much longer than I, have any recommendations for these inexpensive non-antibiotic options?

Have you seen Dr Hagan’s excellent report on dry eye/ Ocular Surface Disease on Med help?

[Milo007]

To both you and Deep Dry Eye, I see you both are on a long term azithromyin treatment for dry eye, or OSD as Dr Hagan on Medhelp says it is called now. Don’t you have concerns about using azithromycin long term because of how long it is retained, causing bacterial resistance?

Well let me explain you about the duration of my azithromycin usage. I used it for a month last year from June-July along with oral doxycycline. I am again on them from 26th February this year. I don't plan to use either of them indefinitely but only for a month. The use of doxycycline and azithromycin in OSD is primarily due to their anti inflammatory properties. There is a always chance of development of bacterial resistance but the benefits out weigh the risks. It is worse to have permanent damage to your ocular surface due to chronic inflammation than to use these drugs to control them and possibly develop bacterial resistance. They won't lose their anti inflammatory properties even if the bacteria in your eyes develop resistance to them. You would always have more potent antibiotics as backup if you need antibiotics later on. So I think it's wise to use these drugs to treat OSD even on a long term basis. They actually don't manifest best results on a short term basis. So go with them on a long term plan.

I am thinking of using it only for 3 days on the eye lids/ lashes and then going to a readily available inexpensive HOCL wipes or spray, either Natrasan , or Heyedrate, or OcuSoft HypoClor Plus (all three much talked about on this web site). For the OSD part of treatment, I don’t see inexpensive non-antibiotic options. I could get Restasis back in the US, partially covered by Medicare,

It's not a good idea to use azithromycin for just 3 days and then discontinue since this would have little to no effect on your OSD. You need at least two weeks (preferably a month) on azithromycin to notice any significant improvement. As I mentioned earlier the antibiotic effect of these drugs are not desired or intended here. They are being used as anti inflammatories. HOCL should be used in conjunction to serve as a control of bacterial overgrowth that might contribute to OSD causing blepharitis. But HOCL is not a substitute for azithromycin or doxycycline in terms of their anti inflammatory effects.

Do either of you, who have been at this “game” much longer than I, have any recommendations for these inexpensive non-antibiotic options?

Yes I have come across several non-steroidal and non-antibiotic options to control inflammation. Some of them are cyclosporine A, lifitegrast, heparin and chloroquine phosphate eye drops. None of them are as powerful as steroids to control inflammation. But they do help.

Have you seen Dr Hagan’s excellent report on dry eye/ Ocular Surface Disease on Med help?

Not yet. I would love to have a look at his report on OSD. Can you share me the link?

[Giacomo]

[Giacomo]

Milo, above is the link to the medhelp article. I hope you find it informative . Dr Hagan is a very informed and responsive contributor

Milo, I didnt mention it, but I have been diagnosed with glaucoma and consequently take daily latanoprost fo reduce intraocular pressure. For this reason, I avoid BAK preservative-based medicines and will avoid steroids

I have been researching other drugs to deal with OSD such as restasis - which is expensive however- and is cyclosporine-based. I would like to find a less expensive alternative

I understand what you wrote about not using azithromycin on a short term basis to control OSD. I was (actually I am) using Azyter for 3 days to control bacteria growth on the eyelashes.. then I plan to change to Natrasan (HOCL) to control bacteria growth in the future. Is this not a reasonable approach?

I realize that Azyter is not Going to have an antibiotic effect on OSD for 3 days, but I assumed it might have an anti bacterial effect on the eyelash area. I say ths because the recommended dosage in the consumer brochure is twice a day for 3 days !!!! Azyter comes packaged with 6 monodose vials

Your suggestions for Restasis alternatives are welcome, preferable less expensive of course, and BAK-free and steroid free

[deep_dry_eye]

Milo, above is the link to the medhelp article. I hope you find it informative . Dr Hagan is a very informed and responsive contributor

Milo, I didnt mention it, but I have been diagnosed with glaucoma and consequently take daily latanoprost fo reduce intraocular pressure. For this reason, I avoid BAK preservative-based medicines and will avoid steroids

I have been researching other drugs to deal with OSD such as restasis - which is expensive however- and is cyclosporine-based. I would like to find a less expensive alternative

I understand what you wrote about not using azithromycin on a short term basis to control OSD. I was (actually I am) using Azyter for 3 days to control bacteria growth on the eyelashes.. then I plan to change to Natrasan (HOCL) to control bacteria growth in the future. Is this not a reasonable approach?

I realize that Azyter is not Going to have an antibiotic effect on OSD for 3 days, but I assumed it might have an anti bacterial effect on the eyelash area. I say ths because the recommended dosage in the consumer brochure is twice a day for 3 days !!!! Azyter comes packaged with 6 monodose vials

Your suggestions for Restasis alternatives are welcome, preferable less expensive of course, and BAK-free and steroid free

Depending on the country you live in, Restasis patent has expired in Canada, and there is generic cycosporin. However, the drs I've talked to say its less effective (due to delivery vehicle).

[Milo007]

Milo, above is the link to the medhelp article. I hope you find it informative . Dr Hagan is a very informed and responsive contributor

Thank you so much. I will definitely have a look at it!

Milo, I didnt mention it, but I have been diagnosed with glaucoma and consequently take daily latanoprost fo reduce intraocular pressure. For this reason, I avoid BAK preservative-based medicines and will avoid steroids

I am sorry to hear that. It's a lifelong issue that needs to be managed. So you cannot use steroids without the supervision of a glaucoma specialist. Make sure whatever glaucoma medication you are using must be preservative free. It's quite possible that the glaucoma medication caused your glands to malfunction. No one knows what are the long term effects of various glaucoma medications on your glands. They are suspected to damage the meibomian and lacrimal glands slowly.

I understand what you wrote about not using azithromycin on a short term basis to control OSD. I was (actually I am) using Azyter for 3 days to control bacteria growth on the eyelashes.. then I plan to change to Natrasan (HOCL) to control bacteria growth in the future. Is this not a reasonable approach?

Quite reasonable! The choice of natrasan is a very smart move. One of our senior members SAAG has extensive experience with natrasan. You can read her posts on the same.

I realize that Azyter is not Going to have an antibiotic effect on OSD for 3 days, but I assumed it might have an anti bacterial effect on the eyelash area. I say ths because the recommended dosage in the consumer brochure is twice a day for 3 days !!!! Azyter comes packaged with 6 monodose vials

If you are using it as an anti bacterial then 3 days are probably enough to control the bacteria. You are going to kill them with HOCL anyway. So the bacteria on your eyelashes are going to R.I.P..

Your suggestions for Restasis alternatives are welcome, preferable less expensive of course, and BAK-free and steroid free

Make sure you use single use vials which are always preservative free.