3 · Anticollagenolytics & anti-melt agents
Doxycycline / tetracyclines (oral) — anti-MMP effect
Review — modulators of corneal healing › 3 · Anticollagenolytics & anti-melt agents › Doxycycline / tetracyclines (oral) — anti-MMP effect
Doxycycline / tetracyclines (oral) — anti-MMP effect
Doxycycline (also minocycline); sub-antimicrobial-dose forms 20–40 mg (Oracea)
Oxford II–IV
Moderate
Present · established
Mechanism of actionIndependent of the antibacterial effect: Zn²⁺/Ca²⁺ chelation at the MMP catalytic site (MMP-8/-9/-13) plus repression of their expression → stromal stabilization; anti-inflammatory (↓IL-1β, TNF-α, neutrophil chemotaxis); meibomian effect (↓lipases). Supports the basement membrane (erosions).
IndicationsRecurrent corneal erosions (with a corticosteroid), stromal melting/ulcer (perforation risk), rosacea/MGD with marginal keratitis, peripheral ulcerative keratitis.
Route & dosageErosions: doxycycline 50 mg twice daily for ~2 months (+ topical corticosteroid). Melting: 100 mg twice daily. Rosacea/MGD: 40 mg modified-release once daily or 20 mg twice daily (sub-antimicrobial dose), for several months.
Level of evidenceOxford II–IV (one RCT for erosions; melting: models + case series) · Scale: Moderate (erosions/rosacea), Weak (melting).
| FDA | Doxycycline approved (antibiotic); Oracea 40 mg approved for rosacea (2006). Corneal anti-MMP use is off-label (established). |
|---|---|
| EU MA | Doxycycline holds an MA (antibiotic); anti-MMP use is off-label but standard practice; low-dose forms available. |
| France | Generic, available; off-label use. |
| USA | Generic, available. |
| Asia | Generic, available. |
Key studies: Dursun et al., Am J Ophthalmol 2001 (recurrent erosions, doxycycline + corticosteroid) — PMID 11438047; RCT on recurrent erosions, 2022.
See also: Gabison E. “Corneal wound-healing agents”. In: SFO 2023 Report — Médicaments et biothérapies en ophtalmologie, chapter 21. Full text, open access (in French).