Oral Azithromycin for the Treatment of Moderate to Severe Meibomian Gland Dysfunction

Objective: To observe the clinical efficacy of oral azithromycin in patients with moderate to severe meibomian gland dysfunction (MGD), and the structural changes in meibomian glands. Methods: This was a prospective clinical study. Forty-nine patients (98 eyes) who had moderate to severe MGD were recruited in the Second Affiliated Hospital, Fujian Medical University, from April 2016 to January 2017. All patients underwent comprehensive ocular surface examination and slit lamp examination and were divided into two groups: 26 patients in the observation group and 23 patients in the control group. The observation group was given artificial tears and oral azithromycin 500 mg once daily for 3 days, then stopped for 7 days. There were 10 days in a treatment cycle with a total of three cycles for the treatment.The control group received only artificial tear treatment. All patients underwent modified meibomian gland compression during the first visit and for each follow-up, all of which were combined with eyelid hot compress and blepharospasm cleaning. Then an ocular check-up was performed, including the following aspects: Ocular surface disease index (OSDI), noninvasive first break-up time (NIF-BUT), noninvasive average break-up time (NIAvg-BUT), tear meniscus height (TMH), R-scan, loss rate of the meibomian gland, assessment of meibomian gland orifices, meibum quality score, meibum expression score, fluorescein stain test (FL), and Schirmer Ⅰ test (SⅠT) between pre-therapy and post-treatment. Data were analyzed by an independent samples t test, Mann-Whitney U test, paired t test and Wilcoxon paired rank sum test. Results: After treatment, the assessment of meibomian gland orifices (Z=-3.093), meibum quality score (Z=-2.501), meibum expression score (Z=-3.175) as well as FL (Z=-2.602) of the control group were improved compared with those before treatment, with statistically significant differences (P<0.05). However, there were no statistically significant differences in other indexes in the control group. After treatment, the OSDI (t=6.174), loss rate of the meibomian gland (t=2.402), assessment of meibomian gland orifices (Z=-5.192), meibum quality score (Z=-5.073), meibum expression score (Z=-4.807), and FL (Z=-3.587) of the observation group were improved compared with those before treatment, with statistically significant differences (P<0.05). There were no statistically significant differences in other indexes in the observation group. Statistically significant differences were observed in OSDI (t=-3.778), NIAvg-BUT (Z=-2.043), loss rate of the meibomian gland (t=-2.123), assessment of meibomian gland orifices (Z=-6.318), meibum quality score (Z=-5.852), meibum expression score (Z=-3.951) and SⅠT (Z=-2.462) between the two groups after treatment (P<0.05) and the observation group improved more obviously, but no statistically significant differences in other indexes after treatment. Conclusions: Oral azithromycin can be used to treat patients with moderate to severe MGD, relieve symptoms and partially regain the function of the meibomian gland. Key words: meibomian gland dysfunction; azithromycin; clinical efficacy