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Lid margin disease

Q:

The conventional teaching for lid margin disease is to use an antibiotic oint to the lid margins at bedtime along with other therapy.

If we continue ointment once alone for a long period, for maintenance, are we not using a subtherapeutic dosage and will this not promote drug resistance.

Would it be better to use Ab. drops QID + same Ab. ointment at night for a week and then stop them abruptly.

One could repeat the same course after a few weeks if deemed necessary.

Would there be any indication to use antibiotic ointment once daily for a prolonged period of time.

Thanks

A:

That traditional teaching is, as you correctly observed, outdated and usually wrong
I never use an antibiotic ointment at bedtime for lid margin disease BC the etiology isn’t infectious and by doing so invariably you’ll confuse the patient into thinking the prescription ointment is the key, so they ignore their warm compresses and lid scrubs, which is actually the important part
Obviously MGD sometimes causes DES by interfering with the lipid component of the tear film. In these cases I sometimes add erythromycin ointment at bedtime. But I always tell them it’s for the lubricating properties of the vehicle, and patients often prefer that substance over something like lacrilube, plus medical insurance pays for it. Then they usually understand
Prior recent threads have discussed treatments for demodex
Hope this is helpful

 

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