Topical Azithromycin Versus Oral Doxycycline For Meibomian Gland Dysfunction - A Systematic Review And Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: FP10.14 | Type: Free paper | DOI: 10.82333/22ef-aq87
Authors: Dr Margarita Safir 1 , Prof. Clara C. Chan 2 , Prof. Michael Mimouni 3 , Dr Itamar Arbel 4 , Dr Ruth Lapid-Gortzak 5 , Prof. Camiel J. F. Boon 5 , Dr Dror Ben Ephraim Noyman* 3
1Ophthalmology,Rabin Medical Center,Petach Tikva,Israel, 2Department of Ophthalmology and Vision Sciences,University of Toronto,Toronto,Canada, 3Ophthalmology,Rambam Health Care Campus,Haifa,Israel, 4Ophthalmology Department,Meir Medical Center,Tel Aviv,Israel, 5Department of Ophthalmology,Amsterdam University Medical Centers,Amsterdam,Netherlands
Purpose
MGD is a common ophthalmologic condition causing progressive damage to the ocular surface. Treatments often include antibiotics, with a recent analysis showing oral azithromycin's superiority over doxycycline. This study compares oral doxycycline and topical azithromycin for MGD treatment
Setting
Systematic review and meta-analysis.
Methods
A comprehensive search of PubMed, Scopus, Embase, and ClinicalTrials.gov identified 3,696 publications (1964–2024) from which randomized controlled trials (RCTs) comparing oral tetracyclines with topical macrolides for MGD were sought. Eligible studies reported outcomes related to tear film stability, meibomian gland function, ocular surface health, or symptom severity. Data extraction followed PRISMA guidelines and risk of bias was assessed using Cochrane methods.
Results
Seven RCTs from distinct locations (408 patients) were included. Regimens were comparable: 1 month of topical azithromycin (1–1.5%, 1-4 times daily) versus 3-8 weeks of oral doxycycline (100-200 mg daily). Both improved MGD signs and symptoms. Topical azithromycin was superior in total symptom score (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.01–2.46) and reduced tear debris (OR, 0.33; 95% CI, 0.15–0.74). Subgroup analysis showed doxycycline was superior for corneal staining (standardized mean difference [SMD], 0.64; 95% CI, 0.22–1.05), whereas 1% azithromycin was superior for tear breakup time (mean difference [MD], –1.28; 95% CI, –2.02 to –0.53) and dropout-causing adverse events (risk ratio [RR], 0.22; 95% CI, 0.08–0.63).
Conclusions
Both topical azithromycin and oral doxycycline are effective for MGD management. Topical azithromycin demonstrated a more favorable safety profile and may be considered a first-line treatment, particularly for patients with low tolerance to systemic medications.