Randomised controlled trial of topical antibacterial Manuka (Leptospermum species) honey for evaporative dry eye due to meibomian gland dysfunction

Clin Exp Optom. 2017 Nov;100(6):603-615. doi: 10.1111/cxo.12524. Epub 2017 Jun 6.


Background: The aim was to evaluate the efficacy of standardised Manuka (Leptospermum species) antibacterial honey as adjunctive twice daily treatment to conventional therapy (warm compresses, lid massage and preservative-free lubricant), in participants with evaporative dry eye due to moderate to advanced meibomian gland dysfunction.

Methods: This prospective, open-label study involved 114 participants. After two weeks of conventional therapy participants were randomised to one of three treatment groups: Optimel Antibacterial Manuka Eye Gel (98 per cent Leptospermum species honey) plus conventional therapy (n = 37), Optimel Manuka plus Lubricant Eye Drops (16 per cent Leptospermum species honey) plus conventional therapy (n = 37) and a control (conventional therapy) (n = 40). Clinical evaluations performed at baseline and Week 8 included: symptom scores (Ocular Surface Disease Index, Ocular Comfort Index), daily lubricant use, tear assessments (break-up time, secretion, osmolarity and InflammaDry), corneal sensation, ocular surface staining, meibomian gland secretion quality and expressibility, bulbar conjunctival, limbal and lid marginal redness and eyelid marginal bacterial cultures and colony counts.

Results: Significant improvements (p ≤ 0.05) occurred at Week 8 in symptoms, tear break-up time, staining, tear osmolarity, meibum quality and bulbar, limbal and lid margin redness for all treatments. Improvement in staining was significantly greater with Optimel 16 per cent drops (p = 0.035). Significant improvements (p < 0.05) in meibomian gland expressibility and InflammaDry occurred for both Optimel treatments. Optimel 98 per cent gel was significantly more effective in improving meibum quality (p = 0.005) and gland expressibility (p = 0.042). Total eyelid marginal bacterial colony counts reduced significantly with Optimel 16 per cent drops (p = 0.03) but not the other treatments. Staphylococcus epidermidis counts reduced significantly with Optimel 16 per cent drops (p = 0.041) and Optimel 98 per cent gel (p = 0.027). Both Optimel treatments significantly reduced the need for lubricants, with Optimel 16 per cent drops decreasing lubricant use most (p = 0.001). Temporary redness and stinging were the only adverse effects of Optimel use.

Conclusions: Optimel antibacterial honey treatments are effective as adjunctive therapies for meibomian gland dysfunction.

Keywords: Leptospermum species honey; Manuka honey; antibacterial honey; dry eye; meibomian gland dysfunction.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Ophthalmic
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Infective Agents, Local / administration & dosage*
  • Bacteria / isolation & purification
  • Combined Modality Therapy
  • Dry Eye Syndromes / drug therapy*
  • Dry Eye Syndromes / etiology
  • Dry Eye Syndromes / physiopathology
  • Eyelid Diseases / complications*
  • Eyelids / microbiology
  • Female
  • Honey*
  • Humans
  • Hyperthermia, Induced / methods
  • Leptospermum / chemistry*
  • Lubricant Eye Drops
  • Male
  • Massage
  • Meibomian Glands / pathology*
  • Middle Aged
  • Osmolar Concentration
  • Prospective Studies
  • Tears / chemistry
  • Tears / physiology
  • Young Adult


  • Anti-Infective Agents, Local
  • Lubricant Eye Drops