Severe Meibomianitis

[JennyW]

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I have a patient with severe meibomianitis that had a bad reaction to doxycycline.

What has been the expereinces of the OMDs out there who have used zithromax or erythromycin for this?

Jenny

 

[Andrew_Doan]

I have a patient with severe meibomianitis that had a bad reaction to doxycycline.

What has been the expereinces of the OMDs out there who have used zithromax or erythromycin for this?

Jenny

Try topical erythromycin ointment. Also emphasize warm compresses and lid hygiene with a hypo-allergenic soap (e.g. Johnson's & Johnson's Baby Shampoo).

Doxycycline used in MGD and blepharitis does not really function as an anti-microbial. Doxy has the beneficial side effect with stabilization of oil flow and production and reducing clogging of the Meibomian glands. Some patients take doxy for 1 year (100 mg PO BID x 1 month, 100 mg PO QD, and if stable 100 mg PO QOD)

Oral Zithromax and erythromycin does not really have any roles for the treatmet of this disorder.

 

[JennyW]

Try topical erythromycin ointment. Also emphasize warm compresses and lid hygiene with a hypo-allergenic soap (e.g. Johnson's & Johnson's Baby Shampoo).

Doxycycline used in MGD and blepharitis does not really function as an anti-microbial. Doxy has the beneficial side effect with stabilization of oil flow and production and reducing clogging of the Meibomian glands. Some patients take doxy for 1 year (100 mg PO BID x 1 month, 100 mg PO QD, and if stable 100 mg PO QOD)

Oral Zithromax and erythromycin does not really have any roles for the treatmet of this disorder.

The patient has tried all topicals/lid scrubs/baby shampoo/hot compresses.

I knew that doxycycline plays a role in the regulation of oil metabolism, so that was what we were trying to do. She was on doxy 100 mg BID for 6 weeks, but had a bad reaction 4 days in.

I read a review article that claimed use of oral zithromax or erythromycin can be effective, but the article admitted it had not really been studied.

Was just wondering if anyone had every tried it. Any other suggestions for oral therapy?

Jenny

 

[mdkurt]

I knew that doxycycline plays a role in the regulation of oil metabolism, so that was what we were trying to do. She was on doxy 100 mg BID for 6 weeks, but had a bad reaction 4 days in.


Jenny

What kind of reaction did she have?

 

[JennyW]

What kind of reaction did she have?

Basically she puked up a storm and turned yellow. Liver function tests were normal, so might have just been a photosensitivity rxn, but she didn't want to take the pills anymore.

Jenny

 

[GlaucomaMD]

Your local formulating pharmacy may be able to make

doxycycline in a drop form that can be instilled in the eye.

Bascom Palmer Eye Institute pharmacy did this in-house as well as Greenpark pharmacy in Houston.

Good luck,

(sometimes these are the most difficult patients I see in my clinic)

 

[ituryu]

What about putting the patient on Quixin or ciloxan eye drops and onitment! They are broad spectrum and highly efficacious againts staph.

 

[Andrew_Doan]

What about putting the patient on Quixin or ciloxan eye drops and onitment! They are broad spectrum and highly efficacious againts staph.

MGD is not an infectious process usually, and broad spectrum antibiotics does not play a major role in management.

Doxy is used to increase flow of oil, not to treat an infection. Lid hygiene and warm compresses are most helpful. Often, MGD is associated with rosacea and doxy is effective in reducing symptoms.

 

[JennyW]

Your local formulating pharmacy may be able to make

doxycycline in a drop form that can be instilled in the eye.

Bascom Palmer Eye Institute pharmacy did this in-house as well as Greenpark pharmacy in Houston.

Good luck,

(sometimes these are the most difficult patients I see in my clinic)

I've not heard of this method being used. Given that the problem is deeper within the eyelid and not a "surface" issue, how likely is the doxycycline to penetrate into the glands to help regulate their function??

I'll give it a try though. She's tried everything else. I have to admit I'm a bit skeptical.

Thanks for the tip though!

Jenny

 

[Andrew_Doan]

Here's an explanation of how doxycyline helps.

http://webeye.ophth.uiowa.edu/dept/SERVICE/CORNEA/Doxycycline/index.htm

 

[JennyW]

Here's an explanation of how doxycyline helps.

http://webeye.ophth.uiowa.edu/dept/SERVICE/CORNEA/Doxycycline/index.htm

That's a good explanation and I was aware of the mechanism but I'm still curious if administering it in a topical form will get enough medication into the glands to work. I've not used topical doxycycline before. Have any of you out there had luck with this method for patients who have had reactions to the oral form?? And was it given BID, TID, QID??

Jenny

 

[Andrew_Doan]

Try Erythromycin PO

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11124676

J AAPOS. 2000 Dec;4(6):379-80. Related Articles, Links


Oral erythromycin treatment for childhood blepharokeratitis.

Meisler DM, Raizman MB, Traboulsi EI.

Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Blepharokeratitis is a chronic external ocular and adnexal inflammatory condition marked by erythematous and edematous lid margins, lid margin crusting and scaling, meibomian gland inflammation and inspissation, and conjunctival hyperemia. The associated keratitis usually involves the inferior cornea and is characterized by punctate epithelial keratopathy and marginal stromal infiltrates. The inflammation sometimes leads to corneal thinning, scarring, and vascularization. The standard therapy for adult blepharokeratitis includes lid hygiene, topical cortico-steroid preparations, and topical antibiotics. Oral tetracycline and its analogues, doxycycline and minocycline, are used in adults to treat associated meibomian gland dysfunction. Whereas blepharitis is common in children, blepharokeratitis is rare and is often associated with severe ocular and psychosocial morbidity. Treatment of youths may be problematic because of poor compliance with lid hygiene and therapy that includes drops and ointment.(1) Furthermore, the use of tetracycline and its analogues is contraindicated in children aged less than 8 years because it may cause dental enamel abnormalities. Isolated case reports have suggested that erythromycin may be a reasonable alternative to tetracycline in childhood blepharokeratitis.(2,3) We report on the successful treatment of this condition with oral erythromycin in 5 children.