clinical topic: blepharitis

[rubensan]

I have had great success in treating blepharitis that is refractory to lid hygeine with oral doxycycline or azithromycin. Recently, I encountered a topical (eye gtt) form of azithromycin marketed for this purpose. Has anyone had experience with this medicine? Does it work?

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[bucknut101]

Our cornea faculty routinely use doxy to treat refactory blepharitis as well. I've noticed they will also use it frequently to treat patients with symptomatic MGD and/or rosacea when tears and hygeine aren't cutting it.
In addition one of our oculoplastics guys puts everyone with a chalazion on doxy as well.

 

[Tux]

Lid hygiene + Terramycin-Polymyxin B tid for 10 days.

Mind sharing the details?

 

[abu barney]

Is this with a defined course of doxy or chronic therapy (similar to acne treatment)?

 

[bucknut101]

Learned an interesting factoid about prescribing doxy last week. Doxy can actually enhance the activity of Coumadin and elevate their INR.
Our staff will always OK giving doxy with their PCP or cardiologist first.

 

[Jokestr]

To Rubensan's question, I have not heard of anyone using or marketing(can u say drug rep) the new Azithro drop for blepharitis. But I think it is an interesting idea, and I'm sure that Inspire Pharmaceutical's would love for physicians to start using AzaSite for blepharitis.

The last comment was interesting. I didn't know that Doxy can affect the INR. Thanks for the new pharm info.

Lastly, I think people will try just about anything for blepharitis, hordeolum, and chalazia. I even know of a faculty who sometimes recommends putting toothpaste on hordeolum. And no, I'm not kidding.

 

[orbitsurgMD]

To Rubensan's question, I have not heard of anyone using or marketing(can u say drug rep) the new Azithro drop for blepharitis. But I think it is an interesting idea, and I'm sure that Inspire Pharmaceutical's would love for physicians to start using AzaSite for blepharitis.

The last comment was interesting. I didn't know that Doxy can affect the INR. Thanks for the new pharm info.

Lastly, I think people will try just about anything for blepharitis, hordeolum, and chalazia. I even know of a faculty who sometimes recommends putting toothpaste on hordeolum. And no, I'm not kidding.

First dilute baby shampoo lid margin scrubs (done eyes closed) QHS. Sometimes this alone is enough.

If not, then Tobradex ointment 1/4 inch OU after scrubs, for 2-3 weeks, switching to erythromycin 0.5% ointment QHS after scrubs. This may be continued indefinitely if necessary.

If more is needed, especially in the presence of acne rosacea, I include Doxycycline 50 mg PO BID for 30 days followed by Doxycycline 50 mg daily for 60 more days. If this is not well-tolerated, there is a lower 20mg tablet preparation available.

I sometimes add MetroGel 1% to be applied to the face once daily (not the eyes or eyelids).

 

[Jokestr]

I just learned last night that there is already a clinical trial ongoing right now for Azasite in the treatment of blepharitis...

 

[bucknut101]

Is the topical azithromycin supposed to suppress meibomian gland secretions and inflammation like doxy? Or is it being used for its antibiotic role?