Azithromycin and MGD: Is it possible to turn an off‐label treatment into an on‐label therapy?

Abstract

AbstractMeibomian gland dysfunction (MGD) is the primary cause of dry eye disease (DED), which afflicts hundreds of millions of people, predominantly women, and is a leading cause of patient visits to eye care practitioners. The impact of moderate to severe DED is comparable to conditions such as dialysis and severe angina, and is associated with significant pain, role limitations, low vitality and poor general health. There is no cure for MGD. The most frequent pharmaceutical treatment in the United States for the management of MGD is the off‐label use of topical azithromycin. This antibiotic is presumed to be effective because of its anti‐inflammatory and anti‐bacterial actions, which may suppress the MGD‐associated posterior blepharitis and growth of lid bacteria. We hypothesize that azithromycin can act directly on human meibomian gland epithelial cells to stimulate their differentiation, enhance the quality and quantity of their lipid production, promote their holocrine secretion and ameliorate MGD pathophysiology. Our results support our hypotheses and may help lead to the approval of topical azithromycin as a safe and effective therapy for human MGD and thereby improve the quality of life of countless people throughout the world. Commercial interest