From the Guidelines
For blepharitis, a good antibiotic therapy is erythromycin ophthalmic ointment 0.5% applied to the lid margins twice daily for 7-10 days, as it provides symptomatic relief and decreases bacteria from the eyelid margin, according to the most recent study 1.
Key Points to Consider
- Before applying any antibiotic, patients should clean their eyelids with warm compresses and gentle lid scrubs using diluted baby shampoo or commercial eyelid cleansers, as this helps remove debris and crusts, allowing better penetration of the antibiotic 1.
- Topical antibiotic treatment can be repeated on an intermittent basis using different kinds of medications with different mechanisms of action to prevent the development of resistant organisms 1.
- For more severe cases, oral doxycycline 100mg once or twice daily for 2-4 weeks may be prescribed, but with caution due to potential side effects, such as photosensitization, gastrointestinal upset, and rare cases of azotemia 1.
- Maintenance therapy with lid hygiene should continue even after the antibiotic course to prevent recurrence, as blepharitis is often a chronic condition requiring ongoing management 1.
Additional Treatment Options
- Oral azithromycin may be used as an alternative to oral tetracyclines, particularly in combination with 0.1% topical tacrolimus, but its use should be cautious due to potential cardiovascular risks 1.
- Topical cyclosporine may be helpful in some patients with posterior blepharitis, and artificial tears, especially those containing oil or lipid-based products, can be helpful for posterior blepharitis 1.
From the Research
Antibiotic Therapy for Blepharitis
- Topical azithromycin ophthalmic solution 1% has been shown to be effective in treating posterior blepharitis, with significant improvements in meibomian gland plugging, meibomian gland secretions, and eyelid redness 2, 3, 4.
- Azithromycin 1% ophthalmic solution has anti-inflammatory properties and has been proposed as a novel treatment for posterior blepharitis, with excellent tissue penetration and regulatory approval for the treatment of bacterial conjunctivitis 5.
- Oral antibiotics, such as doxycycline, may also be used to treat chronic blepharitis, but the evidence is very uncertain and further trials are needed to provide high-quality evidence on their use 6.
Treatment Regimens
- Topical azithromycin ophthalmic solution 1% can be administered twice daily for the first 2 days, followed by once daily for the next 12 days, in combination with warm compresses 2, 4.
- Azithromycin 1% ophthalmic solution can be administered twice a day for 2 days, then every evening for a total of 30 days 3.
- Oral doxycycline can be administered at a dose of 40 mg once a day, or 200 mg twice a day, for a period of 1-3 months 6.
Efficacy and Safety
- Topical azithromycin ophthalmic solution 1% has been shown to be safe and effective, with no serious ocular or systemic adverse events reported 2, 3, 4.
- Oral antibiotics, such as doxycycline, may cause more adverse events, including serious side effects, and their use should be carefully considered 6.