From the Guidelines
Yes, doxycycline is effective for treating ocular rosacea. The most recent and highest quality study, published in 2024 1, supports the use of doxycycline in treating ocular rosacea.
Key Points to Consider
- The typical regimen involves taking 40-100 mg of doxycycline once or twice daily for several weeks to months, with many patients starting at a higher dose (100 mg twice daily) for 2-4 weeks, then reducing to a maintenance dose of 40-50 mg daily.
- Improvement usually begins within 3-4 weeks, but complete treatment may require 3-6 months or longer.
- Doxycycline works by reducing inflammation and inhibiting matrix metalloproteinases that contribute to rosacea symptoms.
- While using doxycycline, patients should avoid direct sunlight, take the medication with food to prevent stomach upset, and not lie down for 30 minutes after taking it.
- Common side effects include photosensitivity, gastrointestinal disturbances, and yeast infections in women.
- For complete ocular rosacea management, patients should also use artificial tears, practice good eyelid hygiene, and avoid triggers like spicy foods, alcohol, and extreme temperatures.
Additional Considerations
- The rationale for the use of tetracyclines, such as doxycycline, is based in part on small clinical trials that report efficacy of the drugs in improving symptoms in patients with ocular rosacea 1.
- Tetracyclines decrease lipase production in both S. epidermidis and S. aureus, and have anti-inflammatory activity 1.
- Tetracyclines can cause photosensitization, gastrointestinal upset, vaginitis, and, rarely, azotemia, and are contraindicated in pregnancy, for nursing women, and for patients with a history of hypersensitivity to tetracyclines 1.
From the Research
Treatment of Ocular Rosacea with Doxycycline
- Doxycycline, an antibiotic, has been studied as a potential treatment for ocular rosacea, a condition characterized by symptoms such as foreign-body sensation, conjunctivitis, blepharitis, and corneal ulcerations 2, 3, 4, 5.
- Research has shown that a sub-antimicrobial dose of doxycycline (40 mg) in a slow-release form can be an effective long-term therapy for ocular rosacea, with significant improvement in symptoms and no reported side effects 2, 4.
- Studies have compared the efficacy of doxycycline with other treatments, such as tetracycline and cyclosporine ophthalmic emulsion, and found that doxycycline can be an effective treatment option for ocular rosacea 3, 5.
- The use of doxycycline at a low dose (40 mg) has been shown to reduce the risk of side effects and antibiotic resistance, making it a potentially safe and effective treatment option for ocular rosacea 2, 4.
Efficacy of Doxycycline in Treating Ocular Rosacea
- A retrospective study found that all patients treated with doxycycline 40 mg in a slow-release form experienced a clear improvement in their ocular rosacea symptoms, with one patient achieving complete clearance and another achieving almost complete clearance 2.
- A case series study found that treatment with doxycycline 40 mg daily resulted in significant improvement in symptoms and blepharitis in patients with ocular rosacea, with minimal side effects 4.
- A randomized controlled trial found that doxycycline 100 mg/day was effective in reducing symptoms of ocular rosacea, although it was associated with a higher risk of gastrointestinal side effects compared to tetracycline hydrochloride 5.
Comparison with Other Treatments
- Doxycycline has been compared with other treatments, such as metronidazole and azelaic acid, and found to be an effective treatment option for rosacea, including ocular rosacea 3, 6.
- Cyclosporine ophthalmic emulsion has been shown to be effective in treating ocular rosacea, although it may not be as effective as doxycycline in some cases 3.