Meibomian gland dysfunction (MGD) is the leading cause of dry eye disease, with a prevalence ranging from 3.5% to 70% depending on factors such as age, sex, and ethnicity [1]. A population-based study conducted on Takushima Island, Japan reported an MGD prevalence of 32.9% [2]. MGD is a chronic condition characterized by obstruction of the terminal ducts or changes in the quality or quantity of meibomian gland secretions (meibum)[3]. In obstructive MGD, hyperkeratinisation of the ductal epithelium reduces the availability of meibum, impairing its ability to coat the aqueous layer of the tear film.[4] This deficiency leads to increased tear evaporation, hyperosmolarity, and bacterial overgrowth at the lid margin [5,6].

Conservative management of MGD typically includes warm compresses, lid hygiene, meibum expression, and, in severe cases, the use of anti-inflammatory medications [7]. Topical azithromycin has demonstrated efficacy in treating MGD due to its anti-inflammatory and antibacterial properties, which can suppress posterior blepharitis and bacterial growth on the eyelids. Emerging evidence also suggests that azithromycin may directly promote the differentiation of meibomian gland cells and stimulate lipid production, alleviating MGD symptoms [8,9].

Azithromycin, a macrolide antibacterial agent, is particularly effective against Cutibacterium acnes. Azithromycin ophthalmic not only exhibits antibacterial and anti-inflammatory effects but also helps regulate lipid production. It is well-distributed and retained in the eyelids, enhancing its therapeutic potential [10,11]. While numerous studies have investigated the use of topical azithromycin for posterior blepharitis, its effects on various parameters—such as lipid layer quality and quantity, tear film stability, lid margin abnormalities, meibomian gland morphology, tear osmolarity, and ocular symptoms—remain insufficiently explored [12, 13].

Tetracyclines are among the earliest broad-spectrum antibiotics that are well-tolerated and easy to administer. They are effective against a wide range of diseases, including plague, cholera, typhoid, syphilis, Legionnaire’s disease, and anthrax. Additionally, some tetracyclines are used to treat conditions such as malaria, Lyme disease, tuberculosis, Rocky Mountain spotted fever, and leprosy. Evidence suggests humans first encountered tetracyclines unintentionally in ancient times, as bone samples over 1,500 years old have revealed traces of these compounds.

Following World War II, tetracyclines were "rediscovered" during an intensive search for new antibiotics at Lederle Laboratories and Pfizer. Their bacteriostatic effect stems from the inhibition of protein biosynthesis. Since the structural elucidation by Robert Woodward, Lloyd Hillyard Conover, and others in the 1950s, tetracyclines have become a significant focus of natural product synthesis research.

This study aimed to comprehensively evaluate the efficacy of azithromycin and tetracycline eyedrops with Meibomitis-Related Keratoconjunctivitis (MRKC), considering a broad range of clinical outcomes.

The study was conducted in the Outpatient Department of Ophthalmology at a tertiary care hospital over a one year, in the year of 2017, following approval from the institutional ethics committee. Written informed consent was obtained from patients or their attendants. patients under inclusion criteria, they were divided into two groups and named as group A & B. Group a patients were treated with Azithromycin, group B patients were treated with tetracycline respectively. Data collected included patients' sociodemographic details, symptoms, MRKC subtypes, conjunctival hyperemia grade, bulbar conjunctivitis and the percentage of conjunctival vascular curvature. These parameters were recorded at baseline and monitored weekly for five weeks during treatment.

Inclusion Criteria

1. Patients aged 20–40 years attending the ophthalmology OPD.
2. Patients able to follow-up schedule.
3. Patients or their attendants willing to provide informed consent.
4. Patients with financial support to purchase required medications.
5. Patients not using any ocular drugs at the time of enrolment.

Exclusion Criteria

1. Patients younger than 20 years of age.
2. Patients wearing contact lenses during the study period.
3. Patients with any ocular disorders.
4. Patients with a history of ocular surgery within the last one months.
5. Patients or their attendants unwilling to provide informed consent.

Study Design

Participants were randomly divided into three groups using the chit method:

• Group A: Patients treated with Azithromycin  
• Group B: Patients treated with Tetracycline

Statistical Analysis

Data collected during the study were recorded in Microsoft Excel and analysed using SPSS software (version 16). An unpaired t-test was conducted to compare the two groups. A p-value of less than 0.05 was considered statistically significant, while a p-value of less than 0.005 was deemed highly significant.

The per the present study majority of the patients were male 55.32 % followed by female 44.67% (Table 01). Table 02 As per the age group of the patients majority of the patients were under the age group of 31 to 35 years 92 (46.70%) patients followed by 36 to 40 years 81 (46.19%).  respectively.

Table 01 Gender distribution among meibomitis associated keratoconjunctivitis patients.

Table 02 Age group distribution among meibomitis associated keratoconjunctivitis patients.

Table 03: effect of Meibomitis related keratoconjunctivitis in different eyes;

Table 04 Bulbar Conjunctivitis in meibomitis associate keratoconjunctivitis patients.

Table 05 Type of meibomitis related keratoconjunctivitis patients.

Table 06: Number of patients had conjunctival hyperemia in meibomitis keratoconjunctivitis patients.

Table 07 Symptoms of conjunctival hyperemia in meibomitis keratoconjunctivitis patients.  146

Table 08 number of patients observed with Conjunctival hyperemia in meibomitis keratoconjunctivitis patients.

The present study was conducted with approval from the institutional ethics committee, and informed consent was obtained from all participating patients. The study population consisted of a majority of male patients (109; 55.32%) compared to females (88; 44.67%) (Table 1). The largest age group was 31–35 years, comprising 92 patients (46.70%), followed by 36–40 years (81; 41.19%), 26–30 years (66; 33.50%), and 20–25 years (21; 10.82%) (Table 2).

Keratoconjunctivitis is defined as inflammation of the eyes, affecting either one or both. In this study, most patients (136; 69.03%) presented with keratoconjunctivitis in both eyes, while 61 patients (30.97%) had it in a single eye (Table 3). Bulbar conjunctivitis associated with meibomitis-related keratoconjunctivitis is caused by vasodilation of the eye's blood vessels. Mild vasodilation was the most common finding (113; 57.36%), followed by moderate (62; 31.47%), severe (13; 6.59%), and no vasodilation (9; 4.56%) (Table 4).

Meibomitis-related keratoconjunctivitis can manifest as either phlyctenular or non-phlyctenular types. In this study, the majority of patients had the phlyctenular type (146; 74.11%), while 51 patients (25.88%) presented with the non-phlyctenular type (Table 5).

The presence or absence of conjunctival hyperemia is a significant factor in the development of keratoconjunctivitis. Most patients (181; 91.87%) exhibited conjunctival hyperemia, while it was absent in 16 patients (8.12%) (Table 6).

Symptoms associated with meibomitis-related keratoconjunctivitis were assessed in 197 patients. Conjunctival hyperemia was present in all patients (197; 100.00%), followed by redness of the eyes (138; 70.05%), watery eyes (129; 65.48%), blurry vision (114; 56.86%), itchy eyes (112; 56.85%), sensitivity to light (95; 48.22%), swelling of the palpebral conjunctiva (75; 38.07%), eyelid margin swelling (71; 36.05%), granulomatous nodules in the cornea (48; 24.36%), and superficial vascularization (31; 15.73%) (Table 7).

Conjunctival hyperemia was monitored across both treatment groups (A and B) over multiple visits. At the first visit, groups A and B included 91 and 90 patients, respectively. After the first week of treatment (second visit), hyperemia was reduced to 83 patients (91.20%) in group A and 79 patients (87.77%) in group B. By the second week (third visit), further reductions were observed: 65 patients (71.42%) in group A and 57 patients (63.33%) in group B. At the third week (fourth visit), 43 patients (47.25%) remained affected in group A and 34 (37.77%) in group B. By the fourth week (fifth visit), conjunctival hyperemia was reduced to 19 patients (20.83%) in group A and 13 (14.44%) in group B. These results indicate that group A demonstrated a greater reduction in keratoconjunctivitis symptoms compared to group B (Table 8).

According to Takashi Suzuki (2016) ^[14], all eyes with phlyctenular keratitis exhibited corneal nodules, neovascularization, and superficial punctate keratopathy, findings absent in normal controls. The mean meiboscore of phlyctenular keratitis patients (upper lid: 2.9 ± 0.3, lower lid: 2.7 ± 0.5) was significantly higher compared to controls (upper lid: 0.4 ± 0.6, lower lid: 0.1 ± 0.3). Noncontact meibography revealed meibomian gland loss in phlyctenular keratitis patients, highlighting a potential link between meibomian gland abnormalities in young individuals and the development of phlyctenular keratitis.

Azithromycin, a macrolide antibiotic, is highly effective in eliminating a wide range of bacteria. According to the study, azithromycin demonstrated greater improvement in treating keratoconjunctivitis compared to tetracycline.

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