{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:07:59Z","timestamp":1784286479166,"version":"3.55.0"},"reference-count":51,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To review the efficacy and safety of oral doxycycline antibiotics versus topical macrolides in the treatment of meibomian gland dysfunction (MGD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A comprehensive search of PubMed, Scopus, Embase, and\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      through December 2024 identified randomised controlled trials (RCTs) comparing oral tetracyclines with topical macrolides for MGD. Eligible studies reported outcomes related to tear film stability, meibomian gland function, ocular surface health, or symptom severity. Data extraction followed PRISMA guidelines and risk of bias was assessed using Cochrane methods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3699 publications (1964\u20132024), six RCTs from distinct locations (374 patients) met inclusion criteria, describing only topical azithromycin and oral doxycycline. Treatment regimens were comparable: one month of topical azithromycin (1\u20131.5%, once to four times daily) versus three to 8\u2009weeks of oral doxycycline (100\u2013200\u2009mg daily). Both treatments significantly improved MGD signs and symptoms. In pooled analyses, topical azithromycin showed superiority in reducing tear debris (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.15\u20130.74); however, while the total symptoms score favoured azithromycin, the result was borderline (OR, 0.62; 95% CI, 0.38\u20131.00) and sensitivity\u2010dependent. Subgroup analysis showed doxycycline was superior for corneal fluorescein staining (standardised mean difference [SMD], 0.64; 95% CI, 0.22\u20131.05), whereas 1% azithromycin was superior for tear breakup time (mean difference [MD], \u22121.40; 95% CI, \u22122.20 to \u22120.60) and dropout\u2010causing adverse events (risk ratio [RR], 0.07; 95% CI, 0.01\u20130.49).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both topical azithromycin and oral doxycycline are effective for MGD management. Topical azithromycin demonstrated a more favourable safety profile and may represent a useful therapeutic option, particularly for patients with low tolerance to systemic medications. However, further high\u2010quality studies are needed to strengthen the evidence base.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.70196","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:38:39Z","timestamp":1784284719000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of topical macrolides versus systemic tetracyclines for meibomian gland dysfunction\u2013a systematic review and meta\u2010analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1814-8316","authenticated-orcid":false,"given":"Margarita","family":"Safir","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Rabin Medical Center, Gray Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara C.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua C.","family":"Teichman","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Vision Sciences University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itamar","family":"Arbel","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Meir Medical Center, Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Lapid\u2010Gortzak","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Amsterdam University Medical Centers  Amsterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6737-7932","authenticated-orcid":false,"given":"Camiel J. F.","family":"Boon","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Amsterdam University Medical Centers  Amsterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4661-0993","authenticated-orcid":false,"given":"Michael","family":"Mimouni","sequence":"additional","affiliation":[{"name":"The Ruth and Bruce Rappaport Faculty of Medicine Technion\u2013Israel Institute of Technology  Haifa Israel"},{"name":"Ophthalmology Department, Rambam Health Care Campus, Ruth Rappaport Faculty of Medicine Technion\u2010Israel Institute of Technology  Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3213-3524","authenticated-orcid":false,"given":"Dror Ben Ephraim","family":"Noyman","sequence":"additional","affiliation":[{"name":"The Ruth and Bruce Rappaport Faculty of Medicine Technion\u2013Israel Institute of Technology  Haifa 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