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Oral antibiotics for chronic blepharitis.

Neil Onghanseng1, Sueko M Ng2, Muhammad Sohail Halim1

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Oral antibiotics for chronic blepharitis show very low certainty evidence for improving clinical signs but may increase adverse events. More research is needed to confirm benefits and risks for this common eye condition.

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Area of Science:

  • Ophthalmology
  • Dermatology
  • Pharmacology

Background:

  • Posterior blepharitis is a prevalent condition affecting 37-47% of ophthalmology patients, increasing with age.
  • It causes ocular surface and lid damage, discomfort, and is linked to conditions like rosacea and meibomian gland dysfunction (MGD).
  • Current treatments focus on symptom relief, but chronic cases are challenging, with oral antibiotics considered for their anti-inflammatory and antibacterial properties.

Purpose of the Study:

  • To evaluate the benefits and harms of using oral antibiotics for individuals suffering from chronic blepharitis.

Main Methods:

  • Conducted a systematic search of multiple databases including CENTRAL, MEDLINE, Embase, PubMed, LILACS, ClinicalTrials.gov, and ICTRP.
  • Included randomized controlled trials (RCTs) comparing oral antibiotics with placebo in adults with chronic blepharitis, including staphylococcal, seborrhoeic, or MGD.
  • Assessed the certainty of evidence for six outcomes using the GRADE classification.

Main Results:

  • Two RCTs with 220 participants were included; meta-analysis was precluded due to differing outcome measures.
  • Very low certainty evidence suggests oral antibiotics may slightly improve clinical signs like tear production and tear film stability, but also may increase serious adverse events.
  • Evidence regarding the effect of oral antibiotics on subjective symptom improvement is very uncertain, with one study showing little effect on OSDI scores.

Conclusions:

  • Insufficient evidence exists to draw definitive conclusions on the efficacy of oral antibiotics for chronic blepharitis.
  • While some clinical signs might improve, the potential for increased adverse events necessitates caution.
  • High-quality research is required to establish clear guidelines for the use of oral antibiotics in managing chronic blepharitis.