The other day a 57 year old woman came in, with a very common complaint, dry eye.

She had dry eye symptoms for a few years previously. Last year, due to Lyme’s disease (infection by Borrelia bacterium which is spread by ticks), her doctor prescribed doxycycline for 14 days. After that, she enjoyed dry-eye free days for almost 8 months, until now when the symptoms are back to haunt her. She tried a few artificial tears which helped only a few minutes. She would really like to have another prescription of doxycycline.

On examination, she has Meibomian gland dysfunction (MGD; here’s my previous article on MGD) and dilated blood vessels on the lid margin suspicious for ocular rosacea. She’s never been diagnosed with rosacea before and denies cheeks turning red.

We know that MGD is a major cause of dry eye, and ocular rosacea (a type of inflammation of the eyelids) will make dry eye worse. In fact, doxycycline has been used off-label to treat MGD and ocular rosacea. In one study, for MGD patients treated with doxycycline for 30 days, about 70% of patients showed some level of improvement after one or multiple (up to three times) treatments ¹.

Therefore, for certain patients who failed conventional warm compress and lid hygiene treatment for MGD, it may be worthwhile to try doxycycline

Of course, doxycycline has several side effects, and should be taken with some caution. Many of the side effects are related to the gastrointestinal health, such as loss of appetite, nausea and vomiting, diarrhea. People may also get sensitivity to the sun, so sun protection while using this medication is recommended. Lastly it may also cause discoloring of teeth, while reversible in adults, may be permanent in kids, so it should not be used in children younger than 8 years of age. Fortunately not too many 8 year olds have MGD or dry eye. Doxycycline also should not be used during pregnancy.

Next time I will talk about an even better alternative drug for MGD. If you read the reference below, you will guess what it is.

References

1. De Benedetti G, Vaiano AS. Oral azithromycin and oral doxycycline for the treatment of Meibomian gland dysfunction: A 9-month comparative case series. Indian J. Ophthalmol. 2019;67(4):464-471.