Antibiotic Eye Drops For Blepharitis

We are starting to see interest from the pharmaceutical companies in the treatment of blepharitis. This is not surprising, considering the prevalence, and chronicity of blepharitis, and the size of the market. Recently, I have noticed some discussion at meetings, and even some clinical trials, using the antibiotic eye drops,  such as azithromycin, or tobramycin, to treat blepharitis. This is clearly an “off label” use of these eyedrops. In other words, it is a treatment which has not been approved by the FDA. This usually means the company that makes the drug did not perform the rigorous clinical trials to demonstrate that the drug works for this condition. Azithromycin and tobramycin ophthalmic solution, like other antibiotic eye drops, are approved for the treatment of bacterial conjunctivitis. So, the effectiveness of these eye drops for blepharitis is largely anecdotal. There have been some studies, or clinical trials, of azithromycin and tobramycin/dexamethasone eye drops for blepharitis. The ones I have seen were not done in a rigorous manner. Some were “open label”. In other words, the patient and doctor knew what drug was being used. Most had no placebo control. In other words, there was no comparison with an inactive eye drop, which may have worked just as well. To know whether these eye drops really works for blepharitis, we will have to await controlled studies in which the doctors and the patients do not know if they are receiving the active drug or the placebo.

From a common sense point of view, an eye drop would not be expected to provide the best treatment for blepharitis. When an eye drop is instilled, most of it immediately washes out of the eye, and a very small amount comes into contact with the eyelid margin for a very brief time. It is hard to imagine that much of the drug penetrates into the meibomian glands, the oil glands of the eyelid. A more logical treatment would be to remove debris, such as oil and dandruff, from the eye lid using lid scrubs. Then, to rub a drop or ointment directly into the lid margin. The latter is the way I currently treat blepharitis in my practice. It would be nice if an eye drop worked just as well. It might be more convenient to use an eye drop than to use lid scrubs and direct application of medication to the lid margins. However, we will need much stronger evidence that eye drops works before doctors can honestly recommend an eye drop over the standard treatment of blepharitis.

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