Background

Dry eye disease (DED) is among the most prevalent ophthalmic conditions but is often underdiagnosed and mistreated. Antibiotics are regularly used to treat DED caused by meibomian gland dysfunction (MGD) or blepharitis, but their use has been questioned.

Objective

To critically evaluate the use of oral and topical antibiotics in DED management.

Methods

A literature search was conducted on November 15th, 2021, in the PubMed database. The search terms were: (antibiotics OR azithromycin OR doxycycline OR minocycline) AND (dry eye disease OR meibomian gland OR blepharitis anterior OR blepharitis posterior OR chronic blepharitis). All relevant original articles with English full-text were included. Case reports and review articles were excluded.

Results

The search provided 619 articles, of which 22 met the inclusion criteria. Oral and topical antibiotics appeared to have short-term positive effects on signs and symptoms of blepharitis- or MGD-related DED. However, these improvements often reverted upon cessation of treatment. The need for repeated treatments and mild adverse events were common.

Conclusions

Current evidence suggests that patients with blepharitis- or MGD-related DED experience short-term benefits of antibiotics. However, evidence for lasting improvement after completed treatment was lacking. Given the unclear long-term benefits, common side effects, and increasing antibiotic resistance seen globally, the existing literature is not sufficient to conclude that antibiotics are useful in long-term MGD management. A survival-analysis of a single round of antibiotics, in addition to the effects of repeated rounds of treatment, on DED parameters could provide useful insights.

中文翻译：

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睑板腺功能障碍和睑缘炎相关干眼症的抗生素治疗——综述

背景

干眼病 (DED) 是最普遍的眼科疾病之一，但往往诊断不足和治疗不当。抗生素通常用于治疗由睑板腺功能障碍 (MGD) 或睑缘炎引起的 DED，但它们的使用受到质疑。

客观的

批判性地评估 DED 管理中口服和局部抗生素的使用。

方法

2021 年 11 月 15 日在 PubMed 数据库中进行了文献检索。搜索词是：（抗生素或阿奇霉素或多西环素或米诺环素）和（干眼病或睑板腺或前睑缘炎或后睑缘炎或慢性睑缘炎）。收录所有相关原创文章，并附有英文全文。病例报告和评论文章被排除在外。

结果

检索提供了 619 篇文章，其中 22 篇符合纳入标准。口服和局部抗生素似乎对睑缘炎或 MGD 相关 DED 的体征和症状有短期积极影响。然而，这些改善通常会在停止治疗后恢复。需要重复治疗和轻微的不良事件很常见。

结论

目前的证据表明，患有睑缘炎或 MGD 相关 DED 的患者会体验到抗生素的短期益处。然而，缺乏在完成治疗后持久改善的证据。鉴于不明确的长期益处、常见的副作用和全球范围内抗生素耐药性的增加，现有文献不足以得出抗生素可用于长期 MGD 管理的结论。单轮抗生素的生存分析，以及重复治疗轮次对 DED 参数的影响，可以提供有用的见解。