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Muckley has no direct financial interest in the products she mentions, nor is she a paid consultant for any companies she mentions. Early oral treatment Tammy P. Than Tammy P.
Because this is an infection located within the meibomian glands, it is often difficult to achieve resolution without systemic management. Therefore, I manage these early with oral antibiotics, often at the initial visit. Topical antibiotics have a difficult time penetrating the meibomian glands, so I will only include a topical antibiotic in the treatment regimen if there is evidence of drainage.
Assuming that the patient has no allergies or other medical history that precludes their use, I will prescribe dicloxacillin 125 mg to 250 mg four times daily for 10 days or cephalexin 250 mg four times daily for 10 days. These oral medications have been available for a long time but are still effective for soft tissue infections associated with the eye.
They are inexpensive and most patients will have been exposed to them before, so tolerability should already be proven.
A relatively new Keflex 750 mg can be taken twice daily, but it is not available generically and is significantly more expensive. I will have the patient continue with warm compresses and return for follow-up in 3 to 5 days or sooner if the condition worsens.
Once the pain is gone, if a mass is still present, I will have the patient begin digital massage following the warm compresses two to four times a day.
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