Targeted Therapies for Meibomian Gland Dysfunction – The Role of Antibiotics in Meibomian Gland Dysfunction Management

Meibomian gland dysfunction (MGD) is a leading cause of evaporative dry eye, significantly impairing the quality of life. Bacterial proliferation and inflammation play central roles in the pathogenesis of MGD, creating a vicious cycle of gland obstruction and ocular surface instability. Antibiotics, particularly tetracyclines (e.g. doxycycline and minocycline), and macrolides (e.g. azithromycin and erythromycin), are widely used as adjunctive therapy for moderate-to-severe or refractory MGD. This review conducted a comprehensive literature search of PubMed, focusing on original peer-reviewed articles published in English that reported on the efficacy and/or safety of oral or topical antibiotics for MGD or blepharitis. Eligible studies were identified using the specific search terms, screened by title and abstract, and selected based on predefined inclusion and exclusion criteria. Relevant data were extracted and synthesized, with an emphasis on randomized controlled trials and comparative studies. The review indicates that both oral and topical antibiotics improve subjective symptoms, tear film stability, ocular surface staining, meibum quality, and lid margin abnormalities in the short term. Oral azithromycin may be at least as effective as doxycycline, with a shorter treatment course and fewer adverse events, while topical azithromycin offers similar or superior efficacy to systemic regimens with reduced systemic exposure. However, benefits are usually limited to active treatment periods, and optimal dosing and duration remain uncertain. Long-term efficacy, safety, risk of resistance, and effects on the ocular microbiome require further investigation. Antibiotics should be used judiciously as part of a comprehensive, individualized management strategy for MGD.