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Efficacy of Zylet vs. Lotemax for the Treatment of Ocular Surface Inflammation/MGD/Blepharitis (ZvL)

This study is ongoing, but not recruiting participants.
Bausch & Lomb Incorporated
Information provided by (Responsible Party):
Massachusetts Eye and Ear Infirmary Identifier:
First received: August 2, 2011
Last updated: October 11, 2016
Last verified: September 2016
This is a Phase IV, single site, randomized, double masked, parallel control clinical trial of 60 subjects to investigate the variance of efficacy between Lotemax® and Zylet® for treatment of ocular surface inflammation due to meibomian gland dysfunction (MGD). Efficacy will be measured by in-vivo confocal microscopy, corneal fluorescein staining, grading of meibomian gland dysfunction and validated ocular symptom assessment questionnaire.

Condition Intervention Phase
Meibomian Gland Dysfunction
Posterior Blepharitis
Drug: Loteprednol/tobramycin
Drug: Loteprednol
Drug: Bausch + Lomb Advanced Eye Relief Lubricant Eye Drops
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Relative Efficacy of Loteprednol (Lotemax®) vs. Loteprednol/Tobramycin (Zylet®) in Treatment of Chronic Ocular Surface Inflammation Associated With Meibomian Gland Dysfunction (MGD)/Posterior Blepharitis

Resource links provided by NLM:

Further study details as provided by Massachusetts Eye and Ear Infirmary:

Primary Outcome Measures:
  • Change in the Presence of Corneal Inflammatory Cells [ Time Frame: 8 weeks ]
    Change in the presence of corneal inflammatory cells from baseline to week 8, as seen by in-vivo confocal microscopy.

  • Change in Ocular Surface Disease Index (OSDI) [ Time Frame: 8 Weeks ]
    Change in Ocular Surface Disease Index (OSDI) from baseline to week 8.

  • Change in Symptom Assessment iN Dry Eye (SANDE) [ Time Frame: 8 Weeks ]
    Questionnaire given to patients to assess both the frequency and severity of dry eye symptoms. Change is quantified from baseline to week 8.

  • Change in Corneal Fluorescein Staining Score [ Time Frame: 8 Weeks ]
    Change in corneal fluorescein staining (NEI grading scheme) from baseline to week 8.

  • Change in Bulbar Hyperemia [ Time Frame: 8 Weeks ]
    Change in bulbar hyperemia from baseline to week 8.

  • Meibomian Gland Disease (MGD) Score [ Time Frame: 8 Weeks ]
    Change in Meibomian Gland Disease (MGD) Score from baseline to week 8.

Enrollment: 60
Study Start Date: August 2011
Estimated Study Completion Date: June 2017
Primary Completion Date: March 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Zylet
Subject randomized to this arm will be treated with Zylet, twice a day, for 4 weeks. Zylet is a combination of loteprednol and tobramycin. Loteprednol is in a class of drugs called corticosteroids. Loteprednol inhibits processes in the body that cause inflammation (swelling). Tobramycin is an antibiotic.
Drug: Loteprednol/tobramycin
Zylet (loteprednol/tobramycin) drops, 1 drop twice a day for 4 weeks.
Other Name: Zylet
Active Comparator: Lotemax
Subject randomized to this arm will be treated with Lotemax, twice a day, for 4 weeks. Lotemax is also known as loteprednol. Loteprednol is in a class of drugs called corticosteroids. Loteprednol inhibits processes in the body that cause inflammation (swelling).
Drug: Loteprednol
Eye drops, 1 drop twice a day for 4 weeks
Other Name: Lotemax
Placebo Comparator: Bausch & Lomb Lubricant Drops
Subject randomized to this arm will be treated with artificial tears, twice a day, for 4 weeks.
Drug: Bausch + Lomb Advanced Eye Relief Lubricant Eye Drops
Bausch + Lomb Advanced Eye Relief Lubricant Eye Drops (Artificial Tears), 1 drop twice a day for 4 weeks.

Detailed Description:

Posterior blepharitis is a common chronic eyelid condition that is described as generalized inflammation of the posterior lid margin and associated with inflammation of the ocular surface and with symptoms of burning, irritation, and discomfort. Posterior blepharitis is associated with various disorders of the meibomian glands, known collectively as meibomian gland dysfunction (MGD). It is associated either with obstruction and inflammation of the meibomian glands or, less commonly, atrophy of the meibomian glands.

Clinically, MGD often presents with inspissated meibomian glands, oily tear film, as well as inflammation and vascularization of the meibomian gland orifices. Papillary hypertrophy of the tarsal conjunctiva and corneal punctate epitheliopathy are often present, and there are prominent associations with dermatoses, such as acne rosacea, seborrhoeic dermatitis, and atopic dermatitis. Evidence from several sources suggests that MGD of sufficient extent and degree is associated with a deficient tear lipid layer, an increase in tear evaporation, and the occurrence of an evaporative dry eye. In fact MGD is considered to be the most common cause of evaporative dry eye. Individuals with MGD often complain of significant discomfort, including burning, itching, irritation, and photophobia. They may also have other associated symptoms of dry eye and may be plagued by blurred vision, gradual contact lens intolerance. Furthermore, these patients may become functionally handicapped by the negative impact of dry eye on their crucial daily activities such as working, reading, using computer, and driving.

Despite the high incidence of posterior blepharitis, there is currently no consistently effective treatment for this condition and it still remains a therapeutic challenge. Posterior blepharitis has traditionally been managed with eyelid hygiene, topical antibiotics (erythromycin or bacitracin ointments), oral tetracyclines (tetracycline, doxycycline, or minocycline) and corticosteroids which are often time consuming, frustrating, and frequently ineffective or variably effective.

The purpose of this study is to compare the effectiveness of topical loteprednol (corticosteroid) vs. the combination of loteprednol and tobramycin (corticosteroid and antibiotic) against an artificial tear. It is critical to determine to what extent the addition of an antibiotic to a topical steroid can enhance the therapeutic efficacy of the treatment.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Male or female
  • At least 18 years of age
  • Has not worn contact lenses, except for bandage contact lens or rigid gas permeable lens, for at least 2 weeks prior to the study and agrees to not wear contact lenses during study
  • Patient is in generally good & stable overall health
  • Minimum corneal fluorescein staining of 1+ in at least one eye
  • OSDI score >30
  • The patient must have a diagnosis of posterior blepharitis
  • A negative urine pregnancy test result for women of childbearing potential
  • Women of childbearing potential must agree to use adequate contraception (hormonal or barrier method of birth control) prior to study entry and for the duration of study participation.
  • Normal lid position and closure
  • Ability to understand and provide informed consent to participate in this study
  • Willingness to follow study instructions and likely to complete all required visits

Exclusion Criteria:

  • History of Stevens-Johnson syndrome or ocular pemphigoid
  • On systemic immunosuppressive regimen
  • History of eyelid surgery
  • Intra-ocular surgery or ocular laser surgery within 3 months
  • History of microbial keratitis, including herpes
  • Active ocular allergies
  • Corneal epithelial defect > 1mm2
  • Use of topical anti-inflammatories, such as steroids, Restasis, or NSAID within the past 2 weeks
  • Any change in dosage of tetracycline compounds (tetracycline, doxycycline, and minocycline) within the last month
  • Use of isotretinoin (Accutane) within the past 6 months
  • Pregnant or lactating women
  • Signs of current infection, including fever and current treatment with antibiotics
  • Active liver, renal, or hematologic disease
  • The use of any other investigational drug
  • Individuals with a known history of glaucoma, individuals with IOP >22 Hg in either eye and individuals with a known family history of glaucoma in primary (first degree) relatives (ie. mother, father, sibling or child)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01456780

United States, Massachusetts
Massachusetts Eye & Ear Infirmary
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts Eye and Ear Infirmary
Bausch & Lomb Incorporated
Principal Investigator: Reza Dana, MD, MPH, MSc Massachusetts Eye and Ear Infirmary
  More Information

Responsible Party: Massachusetts Eye and Ear Infirmary Identifier: NCT01456780     History of Changes
Other Study ID Numbers: 11-048H
Study First Received: August 2, 2011
Last Updated: October 11, 2016
Individual Participant Data  
Plan to Share IPD: Yes

Keywords provided by Massachusetts Eye and Ear Infirmary:
Meibomian gland dysfunction
Dry Eye
Ocular Inflammation
Artificial Tear

Additional relevant MeSH terms:
Pathologic Processes
Eyelid Diseases
Eye Diseases
Lubricant Eye Drops
Loteprednol Etabonate
Ophthalmic Solutions
Pharmaceutical Solutions
Anti-Allergic Agents
Anti-Bacterial Agents
Anti-Infective Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Nasal Decongestants
Vasoconstrictor Agents
Respiratory System Agents processed this record on May 22, 2017