{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:48:55Z","timestamp":1791600535410,"version":"4.3.4"},"reference-count":53,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: This study evaluated the efficacy of topical azithromycin ophthalmic solution (Azyter\u00ae, 15 mg\/g) as second-line treatment for mixed dry eye disease (DED), given the drug\u2019s known non-antimicrobial anti-inflammatory and immunomodulatory properties. Methods: In this pilot, prospective, controlled, non-randomized interventional study, fifteen patients with mixed DED refractory to first-line treatment received topical azithromycin for 30 days (twice daily for 3 days, then once daily for 27 days); ten healthy individuals served as controls. Clinical evaluation was performed before and after treatment in the study group and once in controls, and included the Dry Eye Questionnaire-5 (DEQ-5), Schirmer test, non-invasive tear break-up time (NITBUT, Sirius PLUS corneal topography), tear meniscus height (TMH; Sirius PLUS corneal topography), Efron scale grading of blepharitis, meibomian gland dysfunction (MGD), and conjunctival hyperemia; Oxford-scale grading of corneal fluorescein staining, and corneal epithelial thickness (swept-source anterior segment optical coherence tomography, AS-SS-OCT). Results: After treatment, DEQ-5 scores improved significantly (p &lt; 0.001) and no longer differed from controls. Schirmer test and NITBUT values increased significantly (p = 0.003 and p = 0.027, respectively), becoming comparable to controls. Blepharitis, MGD, and corneal fluorescein staining scores also improved significantly (p &lt; 0.001, p &lt; 0.001, p = 0.002), as did maximum corneal epithelial thickness (p = 0.037). Conclusions: In this pilot cohort, second-line treatment of mixed DED with topical azithromycin significantly improved disease symptoms and signs, supporting its potential as a treatment option. Larger randomized studies are needed to confirm these findings and determine the optimal treatment regimen and duration.<\/jats:p>","DOI":"10.3390\/jcm15197549","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:50:54Z","timestamp":1790614254000},"page":"7549","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment of Mixed Dry Eye Disease with Topical Azithromycin: A Prospective Controlled Pilot Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Bla\u017e","family":"Cestnik","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Ana","family":"Dov\u017eak Fritz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Toma\u017e","family":"Bone","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Spela","family":"Stunf Pukl","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia"},{"name":"Eye Hospital, University Medical Centre Ljubljana, Grablovi\u010deva 46, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.ajo.2025.05.033","article-title":"TFOS DEWS III: Diagnostic Methodology","volume":"279","author":"Wolffsohn","year":"2025","journal-title":"Am. 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