Rx perspective
A Combination Therapy for Blepharitis and Meibomianitis
The Cleeravue-M Kit provides systemic treatment and lid hygiene.
By: James McCulley, M.D.

When patients present with chronic posterior blepharitis or meibomianitis, ophthalmologists have the challenging task of explaining to patients that their painful condition cannot be cured and that it may worsen. Therefore, we must work towards making their chronic conditions livable.

Traditionally, the treatment regimen has consisted of separate therapies, including a course of antibiotics for the systemic problems and lid scrubs for the ocular flora hygiene. While this regimen has been successful, it left the patients to their own devices to find baby shampoo and washcloths or sterile gauze for cleaning the eyelids.

With the soon-to-be released introduction of the Cleeravue-M Kit distributed by Duluth, Ga.,-based StoneBridge Pharma, patients will be able to combine the systemic antibiotic minocycline with the SteriLid (Advanced Vision Research) for lid hygiene.

The kit is intended to bring both acute and chronic blepharitis patients, as well as those with significant meibomianitis, under therapeutic control of their conditions.

Traditionally, tetracyclines have been effective, with minocycline as the preferred anti-inflammatory indicated for these patients. This analogue penetrates the tissues
better and photosensitizes less than other tetracyclines.

Studies we have performed also show how minocycline leads to clinical improvement of signs and symptoms and stabilization in meibomian lipid secretions. Past studies of tetracyclines showed that they do not affect the ocular flora; however, we have also had a microbial effect treating Staphylococcus.

Treatment Regimen

Therapy for posterior blepharitis or chronic meibomianitis patients — whether they present with acne rosacea or not — should involve the kit using minocycline 50 mg b.i.d. and the SteriLid, also b.i.d. In addition, I would prescribe warm compresses, lid massage, and a topical antibiotic ointment such as bacitracin b.i.d. or q.i.d. or a fourth-generation fluorquinolone effective against staphylococcus — depending on the severity of the condition.

Posterior blepharitis often presents with a component of anterior blepharitis, so the SteriLid is indicated for these patients too.

While the majority of the patient population with these ailments could benefit from this kit, there are some patients who may need to be observed closely or who should not be given minocycline. A recent peer-reviewed article suggested that there was an increased risk of breast cancer tied to the number of days a woman has been on systemic antibiotics.¹

I would treat female patients with the Cleeravue kit until I brought them under control for 3 months, and then I would cease the minocycline treatment and evaluate the patient's condition at that point.

This kit should be indicated for patients who are over 12 years old, so physicians can avoid any teeth-development issues a tetracycline may cause in younger patients.

I have found the best treatment regimen for posterior blepharitis or meibomianitis patients is to bring the patient under therapeutic control by treating them for a finite period of time, discontinue systemic treatment and only reinstitute this therapy if the patient's condition exacerbates. However, it is important to maintain local mechanical and hygienic therapy indefinitely.

After bringing the patient under control, I advocate minimal therapy using warm compresses and the SteriLid b.i.d. only.

The Cleeravue-M Kit should make it clear to patients that hygienic maneuvers and the oral antibiotic are keys to therapy. By having the two together, patient compliance is made simpler.

Reference

1. Velicer CM, Heckbert SR, Lampe JW, et. al. Antibiotic use in relation to the risk of breast cancer. JAMA. 2004;291:827-835.