Oral tetracyclines have been the traditional systemic treatment of blepharitis and acne rosacea, through inhibiting bacterial lipase production and reducing fatty acids. However, tetracyclines have a number of adverse side-effects and are required to be taken for a long duration of time, meaning that poor compliance may be an issue amongst patients. Azithromycin is a semi synthetic macrolide, related to erythromycin. It has good intracellular penetration and a long half-life, therefore providing an effective antimicrobial, antioxidant and a favourable immunomodulatory effect without the compliance issues of long-term tetracycline use. The authors performed a retrospective case audit over a one year time period for patients prescribed 500mg oral azithromycin once daily for three days. Eleven patients were included in the study. Nine patients had a diagnosis of meibomian gland disease / acne rosacea and four had dry eye syndrome. Seventy-three percent of participants had previously trialled a three month course of tetracyclines. All patients were reviewed two to three months post azithromycin treatment. No compliance issues were reported in all 11 participants. Eight patients reported a subjective improvement in their ocular surface symptoms, with the remaining three reporting no change. Seven patients had an improvement in one line of best corrected visual acuity (BCVA) compared with their last review. An objective improvement of the ocular surface and lid margin was seen in nine patients. In conclusion, more research is needed to see if oral azithromycin will displace the tetracyclines and become the first line systemic treatment of meibomian gland disease in the adult population in the future.