From the Guidelines
Ophthalmic rosacea should be treated with a combination of eyelid hygiene, artificial tears, and medications, prioritizing oral doxycycline as a first-line option, as recommended by the global rosacea consensus (ROSCO) panel 1.
Treatment Approach
To manage ophthalmic rosacea, the following steps should be taken:
- Daily eyelid hygiene using warm compresses for 5-10 minutes followed by gentle lid scrubs with baby shampoo or commercial eyelid cleansers
- Use of preservative-free artificial tears 4-6 times daily to manage dryness
- Oral doxycycline, a tetracycline antibiotic, as a first-line treatment option, with a dosage of 100mg twice daily for 6-12 weeks, or 40mg daily for a lower-dose option, as supported by the ROSCO panel 1
Additional Treatment Options
For severe cases, the following additional treatment options may be considered:
- Topical metronidazole gel 0.75% or azelaic acid 15-20% applied to affected facial areas twice daily
- Topical cyclosporine 0.05% eye drops for dry eye symptoms
Lifestyle Modifications
To manage ophthalmic rosacea, it is also essential to avoid triggers such as:
- Spicy foods
- Alcohol
- Extreme temperatures
- Harsh skin products These treatments and lifestyle modifications work by reducing inflammation, controlling bacterial overgrowth, and improving meibomian gland function, ultimately improving morbidity, mortality, and quality of life outcomes for patients with ophthalmic rosacea, as emphasized by the ROSCO panel 1.
From the Research
Treatment Options for Ophthalmic Rosacea
- Lid hygiene is a recommended initial treatment for ocular rosacea, with a response rate of 65% 2
- Topical antimicrobials and oral antibiotics are effective treatment modalities, achieving complete or partial response in 91% and 89% of patients, respectively 2
- Intense pulsed light is also a viable treatment option, with a response rate of 89% 2
- Cyclosporine ophthalmic emulsion has been shown to be effective, with a response rate of 87% 2
- Combination treatments can achieve a complete or partial response in 90% of patients 2
Medications for Ocular Rosacea
- Topical azithromycin has been evaluated as a novel treatment for ocular rosacea, with significant improvement in ocular signs and symptoms 3
- Systemic doxycycline has been shown to be effective in treating ocular rosacea, with improvement in blepharitis and meibomian gland dysfunction 4
- Low-dose oral isotretinoin has been compared to doxycycline in the treatment of rosacea, with doxycycline showing more pronounced improvement in ocular symptoms and meibomian gland dysfunction 5
Treatment Guidelines
- International and local guidelines recommend initiating treatment with lifestyle changes, including ocular hygiene and avoidance of triggers 6
- Topical or oral treatment is recommended as the next step, with topical cyclosporine, topical azithromycin, topical tacrolimus, and oral doxycycline being supported by evidence 6
- Combination treatments are also recommended, with the goal of achieving a complete or partial response in patients with ocular rosacea 2, 6