Oral doxycycline has been a mainstay for treating mebomian gland dysfunction (MGD), but now a head-to-head clinical trial has found that oral azithromycin works better, faster, cheaper and with fewer side effects. 

The study, published in February’s British Journal of Ophthalmology, found that both oral azithromycin and doxycycline improved symptoms of MGD. However, patients on azithromycin had relatively better improvement in symptoms and signs along with fewer side effects. 

The researchers randomly assigned 110 patients with MGD to receive either a five-day course of oral azithromycin (500mg on day one, then 250mg/day) or one month of oral doxycycline (200mg/day). Patients continued eyelid warming/cleaning and artificial tears.

When conservative treatment doesn’t work, what’s the best medicine for MGD? A new study finds it’s azithromycin. Photo: Paul Karpecki, OD

After two months, both treatment groups showed a significant improvement of clinical signs and symptoms. But, the percentage of clinical improvement was significantly better in the azithromycin group, with particularly more improvement in conjunctival redness and ocular surface staining. 

In addition, patients in the doxycycline group had more gastrointestinal side effects (26%) than those in the azithromycin group (4%). 

Azithromycin is also much less expensive. “Since MGD is a chronic disease, multiple five-day pulse treatment with azithromycin would be cheaper than long-term daily oral doxycycline,” the authors wrote. 

Alan Kabat, OD, medical director for the TearWell Advanced Dry Eye Treatment Center in Memphis, Tenn., says the study’s findings are welcome news. “I’d rather tell my patients to do something once a day for a week than twice a day for a month, especially if the outcome will be the same,” he says. “Going forward, I will certainly consider using azithromycin one week per month in my recalcitrant MGD patients.”

He emphasizes that oral treatment is not the go-to therapy for patients with MGD, but rather it’s for patients in whom conservative treatment proves insufficient or ineffective.  

Kashkouli MB, Fazel AJ, Kiavash V, et al. Oral azithromycin versus doxycycline in meibomian gland dysfunction: a randomised double-masked open-label clinical trial. Br J Ophthalmol. 2015 Feb;99(2):199-204.