Drugs linked to blepharitis, meibomian gland dysfunction, and chalazion: a real-world, population-based pharmacovigilance analysis.

Background: Blepharitis, meibomian gland dysfunction (MGD), and chalazia are common disorders impacting quality of life. This population-based, pharmacovigilance study aims to identify systemic drugs disproportionately linked to these disorders.

Methods: Data from the Food and Drug Administration Adverse Event Reporting System (FAERS) were analysed (Q4 2003 to Q2 2024). Disproportionality analyses were conducted to identify drugs with ≥10 primary suspect reports for which cases of blepharitis, MGD, or chalazion were overreported, using reporting odds ratios (RORs).

Results: 1923 blepharitis, 202 MGD, and 290 chalazion reports were identified. MGD was overreported for finasteride (ROR = 71.6, 95% CI = 37.9-135.3), while chalazion was overreported for bortezomib (ROR = 73.9, 95% CI = 51.4-106.2). All three conditions were overreported for dupilumab (blepharitis: ROR = 35.7, 95% CI = 22.8-55.9; MGD: ROR = 15.4, 95% CI = 7.3-32.5; chalazion: ROR = 12.6, 95% CI = 5.6-28.5). Safety signals, predominantly associated with blepharitis, were also identified for isotretinoin, docetaxel, panitumumab, cetuximab, tretinoin, alendronate, erlotinib, zoledronate, daxibotulinumtoxinA, and infliximab.

Conclusions: This pharmacovigilance study identified associations between several systemic medications with reports of blepharitis, MGD, and chalazion. MGD and chalazion were overreported for finasteride and bortezomib, respectively, whereas all three conditions were overreported for dupilumab. These findings highlight systemic medications as often overlooked contributors to localised eyelid inflammation. Nonetheless, these drugs are known to reduce morbidity and mortality across many diseases. Therefore, while risks may not necessarily outweigh benefits to warrant changes in prescribing practices, clinicians should remain vigilant for such side effects, particularly in patients at higher risk, and to consider prophylactic measures when appropriate, such as educating patients about eyelid hygiene and counselling them to promptly report symptoms.