From the Guidelines
Ophthalmic rosacea is best treated with a combination of eyelid hygiene, artificial tears, and oral antibiotics, as recommended by the global rosacea consensus panel 1. The treatment approach should prioritize general skincare and eye care measures, including daily eyelid hygiene with warm compresses and gentle lid scrubs using diluted baby shampoo or commercial eyelid cleansers.
- Preservative-free artificial tears should be used 4-6 times daily to manage dryness.
- Oral doxycycline (40-100mg daily) or minocycline (50-100mg twice daily) for 6-12 weeks is the mainstay treatment, as these antibiotics have anti-inflammatory properties beyond their antimicrobial effects 1.
- For moderate to severe cases, topical metronidazole gel 0.75% or azelaic acid 15% applied to affected facial areas twice daily can help control the underlying rosacea.
- Avoiding triggers like spicy foods, alcohol, extreme temperatures, and harsh skincare products is also crucial.
- Topical steroids should be avoided as they can worsen symptoms long-term.
- In severe cases with corneal involvement, ophthalmologist-prescribed topical cyclosporine 0.05% may be needed, as suggested by the blepharitis preferred practice pattern 1. This comprehensive approach targets the inflammatory nature of rosacea while protecting the ocular surface from damage that could potentially lead to vision impairment if left untreated, and is supported by the most recent and highest quality studies 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 treatments, with response rates of 89%, 87%, and 65% respectively 2
Topical Treatments
- Topical metronidazole has been shown to be effective in treating rosacea, with twice-daily dosing of 1.0% cream being as effective as 250 mg tetracycline twice daily 3
- Azelaic acid 15% gel has also been shown to be effective, with once-daily dosing being as effective as metronidazole 1.0% gel dosed twice daily 3
- Topical azithromycin may represent an additional treatment for ocular rosacea, with a shorter duration of treatment and absence of gastrointestinal side effects as compared to systemic doxycycline 4
Oral Antibiotics
- Tetracyclines, specifically doxycycline, are the most commonly prescribed antibiotics for rosacea 5
- Doxycycline has been shown to be effective in reducing inflammatory lesions and erythema associated with rosacea, with a lower dose of 40 mg being as effective as a higher dose of 100 mg but with fewer adverse effects 6
- Macrolides, such as azithromycin, and metronidazole can also be used as oral antibiotics for rosacea 5