Azithromycin eye drops for dry eye appear to help symptoms, but studies have been conflicting. Some studies show it works well but others show it does not really help patients long term (see bold in Reference 2).
Most of the studies I could find that say it does help are usually sponsored by the company. Also the use of Azasite is off label for dry eye and its adverse effects list “Dry Eye” as a side effect (see below).
Still I have a few patients who love this drop, despite it’s cost. It does not do any harm to the eye that we can see.
There is some data showing Azithromycin may help meibomian glands produce more oil (see Reference 3). I am still waiting for good trials to show it does provide good symptomatic relief beyond a few months as well.
1. ADVERSE REACTIONS
Because clinical trials are conducted under widely varying conditions, adverse reaction
rates observed in one clinical trial of a drug cannot be directly compared with the rates
in the clinical trials of the same or another drug and may not reflect the rates observed
The data described below reflect exposure to AzaSite in 698 patients. The population was
between 1 and 87 years old with clinical signs and symptoms of bacterial conjunctivitis.
The most frequently reported ocular adverse reaction reported in patients receiving AzaSite
was eye irritation. This reaction occurred in approximately 1-2% of patients. Other adverse
reactions associated with the use of AzaSite were reported in less than 1% of patients and
included ocular reactions (blurred vision, burning, stinging and irritation upon instillation,
contact dermatitis, corneal erosion, dry eye, eye pain, itching, ocular discharge, punctate
keratitis, visual acuity reduction) and non-ocular reactions (dysgeusia, facial swelling,
hives, nasal congestion, periocular swelling, rash, sinusitis, urticaria).
2. Assessment of efficacy of topical azithromycin 1.5 per cent ophthalmic
solution for the treatment of meibomian gland dysfunction
Clin Exp Optom 2018; 101: 18–22 DOI:10.1111/cxo.12557
Ozlem Balci MD
Gokhan Gulkilik MD
Department of Ophthalmology, Istanbul Medipol
University School of Medicine, Istanbul, Turkey
Submitted: 21 November 2016
Revised: 3 March 2017
Accepted for publication: 16 March 2017
Background: The aim was to evaluate the clinical efficacy of topical azithromycin 1.5 per
cent ophthalmic solution in treatment of the clinical signs and symptoms associated with
meibomian gland dysfunction (MGD).
Methods: In this retrospective study, 35 patients with MGD were treated with topical azithromycin
1.5 per cent ophthalmic solution for 30 days. Topical azithromycin 1.5 per cent
ophthalmic solution was prescribed twice daily for two days and then once daily for a total
of 30 days. Daily lid hygiene with dilute baby shampoo was instructed for all patients.
Patient total symptom score, meibomian gland grading score, Schirmer score with anaesthetic,
tear film break-up time (TFBUT) and corneal fluorescein staining score were evaluated
at baseline and after one and three months.
Results: Patient total symptom score, meibomian gland grading score, Schirmer score
with anaesthetic, TFBUT and corneal staining score reduced significantly from the baseline
to the first month (p < 0.05, for each); however, at the third month, there was no significant
difference from baseline in the meibomian gland grading score, Schirmer score
with anaesthetic, TFBUT and corneal fluorescein staining score (p > 0.05, for each).
Conclusion: These results demonstrate that topical azithromycin 1.5 per cent ophthalmic
solution appears effective in the short-term treatment of the clinical signs and symptoms
associated with MGD.
In our study, significant improvements
were achieved one month after topical azithromycin
1.5 per cent ophthalmic solution
in all clinical signs and symptoms associated
with MGD; however, the improvements
in clinical signs did not persist
during the three-month follow-up.
3. Curr Eye Res. 2018 Jun;43(6):683-688. doi: 10.1080/02713683.2017.1418894. Epub 2017 Dec 28.