Azasite for MGD

























meibomian gland dysfunction is a super common form of blepharitis or eyelid margin inflammation. i see at least a few cases a week, some of them I classify as "raging". blepharitis & MGD can be responsible for all of the following symptoms & more:

BURNING...probably the #2 cause of burning behind dry eye
blur
dryness
red/irritated eyelids
frequent stye formation
loss of eyelashes

traditionally the treatment for both MGD & other forms of blepharitis have been warm compresses & "lid scrubs" like you see up top (Ocusoft brand...thats my favorite).

I still think lid scrubs is the best way to treat MGD. however for some patients lid scrubs aren't enough, and some patients aren't coordinated enough or compliant enough to reliably do eyelid cleansing.

well now studies show that a macrolide antibiotic eyedrop called Azasite works well to treat MGD. antibiotic eyedrops in general usually don't work well against MGD & bleph, but Azasite does b/c of its inherent anti-inflammatory properties as well as its ability to modify eyelid metabolism & oil-secretion function.

I have yet to Rx Azasite for MGD, but after reading about it more today, I'm going to try it for my next "raging" case of meibomian gland dysfunction.

Comments

  1. here's a good article about it http://www.eyecareeducators.com/site/new_treatment_for_meibomian_gland_dysfunction.htm

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  2. I have blepharitis and just had to have two chalazions removed as a result (did it this morning my eye is completely bruised over), my opth recommended I throw out all my old makeup and wash my eyes at night with johnson & johnson baby shampoo & perform warm compresses three times a day. Hope this helps!

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  3. really? baby shampoo? that's old school & IMO not very effective. how about ocusoft lid scrubs instead?

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  4. I've seen three opt amplifier over the past 3 months as well as optometrist and all recommended Johnson & Johnson baby shampoo. The only one that mentioned Ocuscrub was the optometrist and that was to first remove makeup and then do the scrub w/ shampoo

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  5. I personally never recommend baby shampoo for blepharitis or MGD anymore. its old school, its not what it was designed for, and too many patients do it worng (they "wash their EYES" with it)

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  6. Do you still have the same thoughts today about Azasite that you did when you posted this? Is it still an effective treatment?

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  7. I do. I have been Rx'ing it in cases where lid scrubs alone don't make a dent, and it really works. it gets expensive to use it chronically so I end up "pulse-dosing" it (on & off).

    also - I see that my old linked pics don't work. should I fix them? nah. well ok maybe later

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  8. So other than lid scrubs, warm compresses, IPL/Lipiflow, and Azasite, are there any other treatments for MGD?

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  9. If someone has "mild MGD", is it probable that they would be able to wear contacts comfortably again once that person started using some form of treatment?

    Any suggestions for how I can make sure my "mild MGD" doesn't prohibit me from wearing contacts ever again?

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  10. "If someone has "mild MGD", is it probable that they would be able to wear contacts comfortably again once that person started using some form of treatment?"

    of course every case is different and it depends on the severity of the problem, but in theory and for most people, YES probably

    "Any suggestions for how I can make sure my "mild MGD" doesn't prohibit me from wearing contacts ever again?"

    no, sorry. treat the MGD. that's all you can do. no guarantees it will work and no guarantees it won't come back

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  11. I have two questions regarding MGD:

    1. Does MGD tend to be temporary or permanent?

    2. I have been told I have MGD and I notice that my UPPER eyelids always seem to burn and throb. Is this normal?

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  12. "1. Does MGD tend to be temporary or permanent?"

    usually chronic ("permanent")

    "2. I have been told I have MGD and I notice that my UPPER eyelids always seem to burn and throb. Is this normal?"

    normal for MGD, yes

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  13. How exactly does Azasite affect the meibomian glands? Does it just clear up the blockages or does it actually increase the amount of oil that flows?

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  14. I don't think anyone knows EXACTLY how azasite helps. it's thought that it softens the secreted oils from the meibomian glands ("clears up blockages"). but I don't think anyone really knows.

    it probably does not increase oil production

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  15. Thanks for your help! I'm going to ask my eye doctor if it is something that would be right for me. Do you know if the risk of developing cataracts is something that should be a concern with long term use of Azasite?

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  16. Cataracts are absolutely not a concern with azasite use

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  17. Is it only the meibomian glands that can become clogged or are the lacrimal glands at risk of clogging as well?

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  18. Lacrimal glands are not in your eyelid margin and don't get clogged

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  19. What are your thoughts on Total Lid Care ointment? (www.totallidcare.com)I can't find too many reviews of it online.

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  20. "MEH". I'm not a fan. probably doesn't hurt any but IMO isn't some miracle new treatment

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  21. So I'm reading about these Demodex mites and the symptoms they mention really summarize how I am feeling. Is there a way to find out if I have these Demodex things? Is this a normal thing eye doctors look for when they identify their patient as someone with MGD?

    Most important, how do I get rid of them? I have read that many oils that people use to kill them could be bad for the eye. Do you have a recommended treatment for Demodex specifically?

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  22. I am a fan of lid scrubs. routine lid scrub treatment is enough in most cases IMO. if you keep removing them, you don't need to "kill the eggs" etc etc with "tea tree oil" etc

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  23. Is it a common procedure for all eye doctors to look at the eyelash under the microscope and determine the number of demodex on the patient's eyelash or should I go to a specialist if I want that? I have read about this and think it might help solve my MGD issues but don't know where to go.

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  24. most OD's & OMD's can and will do it if you ask or if they suspect that could be the cause obviously...but no I would not consider it "common procedure" to specifically look at the lashes very closely for demodex.

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  25. Is there a problem using Azasite for long periods of time because it has the preservative BAK?

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  26. only if you're sensitive to BAK...

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  27. Do the effects of lid scrubs increase as time goes on or should people expect the same benefit on day 100 as they had one day 1?

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  28. generally no increase in effect over time. so...same benefit on day 100

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  29. In the case of MGD, what is better-- a warm compress or a cold compress? I know that a warm compress is needed to loosen up the overly thick oil but won't that just cause the inflammation to get even worse making it harder for the oil to travel?

    And on the other side of the same coin, wouldn't a cold compress make the already thick oil even thicker, but yet decrease swelling?

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  30. yes and yes. hot compress: loosen oil so it can be expressed...BUT ALSO temporarily make the inflammation WORSE (redder)

    cold compress: temporarily RELIEVE redness and inflammation...BUT make the meibum THICKER.

    you got it. one of the many, many contradictions in medicine. this stuff happens all the time with all kinds of conditions. medical treatments are almost always "give and take" or "risk and reward". it's never as cut & dried as most patients think it is or would like it to be.

    most of the time for known cases of MGD most docs (myself included) think the HOT compresses are the way to go. even tho it makes your lids temporarily MORE inflamed...in theory you're getting at the REASON they're inflamed...vs using cold compresses which give you some relief but don't "solve" the problem

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  31. Do you think an overgrown population of Candida can be responsible for MGD or inflammation of the meibomian glands?

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  32. What are the causes of lipid deficiency?

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  33. Is it normal to lose eyelashes everyday with blepharitis? Once I get my condition under "control", will they grow back?

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  34. no I would not consider losing eyelashed "normal". that implies pretty severe inflammation. yes, in theory they usually grow back

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  35. I was told that I had mild blepharitis. I have been doing warm compresses and lid scrubs for almost 4 months. I do not really see a change in my symptoms at all. I'm not sure of the type of blepharitis that I have, but I lose eyelashes everyday along with feeling like there is grit in my eyes all day. My eyes also feel tired and extremely dry at times. I also have red lids in the morning that seems to calm throughout the day. My optometrist prescribed me fluorometholone drops that helped in the beginning. However, when I was done with the prescription the symptoms returned. He said that I was losing lashes because of the overgrowth of bacteria. He decided to refer me to an opthamologist in a couple of weeks. Is there any type of med that would help me control the overgrowth of bacteria? Until my appointment, do you have any suggestions or comments for me? I would greatly appreciate it.

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  36. nah not really. if you're still losing lashes even with lid scrubs then I agree something more probably needs to be done. oral doxycycline and/or azasite or something.

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  37. Hello. I love this post and find it very helpful. My eyes seem to burn and sting very much, and I've been told that I have blepharitis/ MGD related to rosacea. However, the warm compresses and doxycycline don't do much, but I was told that scrubs are useless for me since I just have an oil problem and no bacteria problem. The concern is that even when I use Systance Balance with an oil base every two hours, my eyes burn like there is soap in them. I would love to hear your thoughts- I've tried scrubs, bunt only for a few days or couple of weeks until I get discouraged and have little relief and give up. Thank you!

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  38. I have blepharitis and dry eyes. Unfortunately, as a result, I have extreme eyelash loss (just a couple of days ago I counted twenty-two eyelashes that fell out! Half of the top of my left eye). I tried everything: Ocusoft lid scrubs, Tobradex, bacitracion (which actually made the lashes clump together and fall out more). Recently I started taking Doxycycline. Today was the first day I took Azasite - and it burned like hell. Is this normal? Do you think that the Azasite will stop my eyelash loss? Is there anything to stop it? Its so depressing and frustrating (I am a 22 year old female and I guess I'm a little self conciseness about the big spaces of empty lashes)

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  39. Yes it burns. No I don't think it will stop your lash loss in its tracks. I hope it does and its a decent idea, I would just be surprised if it worked quickly to stop it

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  40. Do you have any suggestions for eyelash loss due to blepharitis?

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  41. I'm sorry I should have been more specific. Do you have any suggestions on how to stop your eyelashes from falling out due to blepharitis. Does Doxycycline help? Thanks for the suggestion about Latisse for regrowth.

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  42. no, I'm sorry. not really any great answers here. the real answer is: get rid of the bleph. well that's easier said than done sometimes, as you well know. so...no I'm sorry I have no great insight for you here.

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  43. are you still active on this post? If so, my question is, since studies show many cases of MGD are assymptomatic, are the symptoms I'm feeling more in my head than in my eyes? If M secretion thickening and MG atrophy is normal part of aging wouldn't everyone feel as I do with MGD? MUST MGD be treated or is end-stage glad dysfunction inevitable with the actual pain or feelings of dryness associated with it actually being optional (and a result of personality and attention/stress given to the MGD, rather than existence of the physiological changes?)

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    Replies
    1. "are you still active on this post?"

      yes

      "If so, my question is, since studies show many cases of MGD are assymptomatic, are the symptoms I'm feeling more in my head than in my eyes?"

      unlikely

      "If M secretion thickening and MG atrophy is normal part of aging wouldn't everyone feel as I do with MGD?"

      no

      "MUST MGD be treated"

      no

      "or is end-stage glad dysfunction inevitable"

      no

      "with the actual pain or feelings of dryness associated with it actually being optional (and a result of personality and attention/stress given to the MGD, rather than existence of the physiological changes?)"

      yes

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  44. wow, great glad you are still active on this post thanks. So, I'm a bit confused by the response. This is the pain I feel in MGD (for me specifically): only occasional daytime dry eye where it feels like surface of eye stings a bit with what I'm assuming is tear evaporation--similar to eye stinging when peeling an onion, decreased toleration for wearing my soft contact lenses (in fact I gave up on them now 2 years ago when I also started presbyopia) but the major source of irritation is pain after 3 hours of sleep that wakes me up, at that point unbearable dryness then if I dare forgoe warm compresses or eye drops I suffer an strong 'pinching' sensation in my edges of eyelids (I am imagining it is pressure of blocked up MG?)

    So I'm confused when you respond that symptoms I feel are "unlikely" just in my head yet you answered "yes' about my pain being more due to my personality and focus on MGD rather than physiology?

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    1. the mannor in which you rattled off a lot of questions/comments that you wanted responses to was confusing.

      TL;DR version: dry eye sucks.

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  45. Is the azasite systemic at all? Or does it not go any further than the eyelids and eye surface? Are you suppose to instill directly onto the eyeball or try to get it mainly on the lid margin? Thanks

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  46. not systemic at all. doesn't matter a whole lot IMO whether you instill it "in the eye" or if you "try to get it mainly on the lid margin"

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  47. In your experience, how effective is Azasite for redness in the eyes (inflamed blood vessels) caused by MGD, and how long typically should the redness stay away after treatment is done? Also, does azasite treat redness in the eye caused by ocular rosacea? Thank you so much.

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    1. I don't have a lot of experience b/c I never really got on board with Rx'ing Azasite for MGD. Nobody really did. Azasite is likely not to do much for any redness of any kind.

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    2. Thanks for your quick reply Michael. A couple other questions I'd love for you to answer:

      -How about doxycycline for the issue of burning and redness, is it something that you'd recommend for someone like me who has exhausted several other options? These have been my most disruptive symptoms of my MGD and I've read that doxy can provide relief here.

      -I'm wondering if ocular rosacea needs to be treated more vigorously than MGD/ if it is potentially more harmful.

      -Lastly, is exercise is bad for MGD? I notice it does omake symptoms worse temporarily.

      Thanks again, your repsonses and this blog are extremely helpful.

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    3. nah oral doxy is probably not going to do a whole lot for redness and burning. it's a cheap thing to try, tho. "-I'm wondering if ocular rosacea needs to be treated more vigorously than MGD/ if it is potentially more harmful" - debatable. "Lastly, is exercise is bad for MGD? I notice it does omake symptoms worse temporarily" no, exercise is not bad for MGD

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  48. Thanks a lot Michael. Have you seen a lot of patients whos MGD has been significantly improved from Omega 3 supplements?

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  49. no. omega 3 works pretty well IMO for dry eye, but not for MGD (or anything else really...)

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