tetracyclines for blepharitis

tetracyclines for Chronic blepharitis

• one of the most difficult ocular diseases to treat
• 6 types: staphylococcal, seborrheic, seborrheic with staph infection, seborrheic with meibomian seborrhea, seborrheic with spotty inflammation of the meibomian glands, primary meibomianitis
• 2/3 of primary meibomianitis have associated skin condition, acne rosacea
• tetracyclines shown to be effective at treating primary meibomianitis 
• inhibit lipase activity and decrease the release of noxious free fatty acids
• minocycline given 50 mg daily x 2 weeks followed by 100 mg daily until end of study for 6 months
• also doses of 50 mg BID has been studied successfully showed symptom improvement compared to placebo
• meibum is the lipids that come from meibomian glands of patients with primary meibomianitis
• meibum was collected and contains wax and sterol esters, free cholesterol, triglycerides, and diglycerides
• minocycline had greatest effect on decreasing diglycerides, free fatty acids, and cholesterol
• fatty acids and diglycerides promote inflammation
• free cholesterol stimulates bacterial growth
• minocycline decreases fatty acids production and ROS produced by neutrophils
• tetracyclines reduce cytokine levels (IL-6, IL 1b, IL17a, TNFalpha)
• novel anti-inflammatory approach
• tetracyclines also used in ocular rosacea, corneal inflammatory disease, corneal infections
• effects not related to anti-biotic effects -- reduce the free fatty acids that are formed by bacteria on the eyelids
• should also recommend warm compresses 1-4 x day to increase flow of oil from the meibomian glands and help open clogged pores