From the Guidelines
Ophthalmic rosacea is best treated with a combination of eyelid hygiene, artificial tears, and oral antibiotics, as recommended by the most recent guidelines 1. To manage ophthalmic rosacea, start with daily warm compresses applied to closed eyelids for 5-10 minutes, followed by gentle eyelid cleansing using diluted baby shampoo or commercial eyelid cleansers. Use preservative-free artificial tears 4-6 times daily to manage dryness. For moderate to severe cases, oral doxycycline (40-100mg daily) or minocycline (50-100mg twice daily) for 6-12 weeks is effective due to their anti-inflammatory properties beyond their antimicrobial action, as supported by recent studies 1. Topical treatments include metronidazole gel 0.75% applied to affected skin and azithromycin eye drops for ocular symptoms. For severe inflammation, short courses of topical steroids may be prescribed under ophthalmologist supervision. Some key points to consider in treatment include:
- Avoiding triggers like spicy foods, alcohol, extreme temperatures, and harsh skincare products
- Using omega-3 fatty acid supplements to help reduce inflammation, as suggested by the global rosacea consensus panel 1
- Seeking immediate ophthalmologic care if symptoms include significant eye pain, vision changes, or severe redness, to prevent complications like corneal ulceration. This comprehensive approach addresses both the inflammatory nature of the condition and helps prevent long-term ocular damage, in line with the latest recommendations from the field of ophthalmology 1.
From the Research
Treatment Options for Ophthalmic Rosacea
- Lid hygiene, topical and oral antibiotics, cyclosporine ophthalmic emulsion, oral vitamin A derivatives, and intense pulsed light are treatment options for ocular rosacea 2
- Topical antimicrobials and oral antibiotics are the most effective treatment modalities, achieving complete or partial response in 91% and 89% of patients respectively 2
- Intense pulsed light, cyclosporine ophthalmic emulsion, and lid hygiene are also effective treatment options, with response rates of 89%, 87%, and 65% respectively 2
Specific Treatments for Ocular Rosacea
- Cyclosporine ophthalmic emulsion is significantly more effective than artificial tears for treating ocular rosacea, with improved Schirmer scores, tear break-up time, and corneal staining scores 3, 4
- Topical azithromycin is a novel treatment for ocular rosacea, with significant improvement in ocular signs and symptoms, and is well tolerated with mild side effects 5
- Oral antibiotics, such as doxycycline, are commonly used to treat rosacea, including ocular rosacea, and have been shown to be effective in reducing symptoms 3, 6