What is the treatment for ocular rosacea using doxycycline (antibiotic)?

From the Guidelines

Doxycycline is an effective treatment for ophthalmic rosacea, and the recommended dose is 40 mg once daily, which utilizes the drug's anti-inflammatory properties at a dose below that which can typically kill bacteria. This dose has been shown to be as effective as 100 mg once daily for moderate-to-severe rosacea 1. The treatment should be allowed sufficient time to take effect, typically 6-12 weeks, before considering it a failure and choosing another option 1.

Some key points to consider when treating ophthalmic rosacea with doxycycline include:

• Take doxycycline with a full glass of water, either 1 hour before or 2 hours after meals, and avoid taking it before lying down
• Common side effects include photosensitivity, gastrointestinal upset, and yeast infections
• Doxycycline works by reducing inflammation and decreasing bacterial lipases that contribute to meibomian gland dysfunction
• While treating with doxycycline, maintain good eyelid hygiene with warm compresses and gentle lid cleansing, use preservative-free artificial tears for dryness, and continue any prescribed topical treatments
• Improvement typically begins within 2-4 weeks, but complete resolution may take several months
• Avoid doxycycline if pregnant, breastfeeding, or in children under 8 years old due to potential tooth discoloration and bone growth effects

It's also important to note that doxycycline 40 mg has been shown to be superior to placebo and noninferior to doxycycline 100 mg in the treatment of rosacea 1. Additionally, the long-term efficacy and safety of modified-release doxycycline as monotherapy has been demonstrated in a two-part study, which showed that once-daily doxycycline maintenance therapy enhanced long-term rosacea control 1.

From the Research

Treatment of Ophthalmic Rosacea with Doxycycline

• Ophthalmic rosacea can be treated with doxycycline, which is usually administered at a dose of 40-100 mg daily for 3-6 months 2.
• A sub-antimicrobial dose of slow release doxycycline 40 mg daily is an effective long-term therapy for ocular rosacea, with no associated side effects of long-term antibiotic therapy or risk of resistance 3.
• The treatment of ocular rosacea with once-daily low-dose doxycycline has been shown to be effective, with significant improvement in symptoms and clinical findings after 12 weeks of treatment 4.

Dosage and Administration

• The recommended dose of doxycycline for the treatment of ophthalmic rosacea is 40 mg daily, administered in a slow-release form 3, 4.
• The treatment duration can vary, but it is typically administered for at least 2-3 months, with some studies showing efficacy after 12 weeks of treatment 3, 4.

Efficacy and Safety

• Studies have shown that doxycycline is effective in reducing the symptoms of ophthalmic rosacea, including blepharitis, conjunctival redness, and corneal ulcerations 3, 4.
• The use of sub-antimicrobial dose doxycycline has been shown to be safe, with minimal side effects and no increased risk of antibiotic resistance 3, 5.
• However, doxycycline is contraindicated in pregnant or nursing women, and in infants and children due to the risk of permanent teeth discoloration and decreased bone growth rate 5.