From the Guidelines
Treatment for ocular rosacea should involve a combination of eyelid hygiene, medications, and lifestyle modifications, with a focus on reducing inflammation and preventing long-term damage, as recommended by the global rosacea consensus panel 1.
Key Components of Treatment
- Daily eyelid cleaning with warm compresses and gentle cleansers to remove debris and reduce inflammation
- Artificial tears for dry eye symptoms, used as needed throughout the day
- Prescription medications, such as topical antibiotics like erythromycin or bacitracin ointments, and oral antibiotics like doxycycline (50-100mg daily) or minocycline (50-100mg daily) for 6-12 weeks, which work through anti-inflammatory properties rather than antimicrobial effects 1
- For more severe cases, topical cyclosporine or low-dose steroid eye drops may be prescribed under ophthalmologist supervision, with caution due to potential adverse effects like increased IOP and cataract 1
Lifestyle Modifications
- Avoiding triggers like spicy foods, alcohol, extreme temperatures, and sun exposure
- Using sunscreen and wearing protective eyewear outdoors
- Considering diet modification, although the evidence is not well-documented, and the role of dietary supplementation with essential fatty acids is still being studied 1
Ongoing Management
- Regular follow-up with an eye care professional to monitor the condition and adjust treatment as needed
- Long-term management is necessary, as ocular rosacea is a chronic condition
- Maintenance therapy should be discussed, and guidelines should be established to minimize the risk of adverse effects from corticosteroid use 1
From the Research
Treatment Options for Ocular Rosacea
The treatment for ocular rosacea includes various options, such as:
- Lid hygiene
- Topical and oral antibiotics
- Cyclosporine ophthalmic emulsion
- Oral vitamin A derivatives
- Intense pulsed light
Effective Treatment Modalities
According to a systematic review 2, the most effective treatment modalities for ocular rosacea are:
- Topical antimicrobials, which achieved complete or partial response in 91% of patients
- Oral antibiotics, which achieved complete or partial response in 89% of patients
- Intense pulsed light, which achieved partial response in 89% of patients
- Cyclosporine ophthalmic emulsion, which achieved complete or partial response in 87% of patients
Treatment for Pediatric Ocular Rosacea
A study on pediatric ocular rosacea 3 found that treatment with an eyelid-warming device and topical azithromycin 1.5% led to rapid improvement in clinical signs and was well tolerated by all patients.
General Treatment for Rosacea
Other studies 4, 5, 6 suggest that topical metronidazole, sulfacetamide/sulfur, and azelaic acid are effective for mild rosacea, while combination therapy with oral tetracyclines and topical agents is the first-line choice for moderate papulopustular rosacea. Cyclosporine ophthalmic emulsion is also effective for ocular rosacea.
Combination Treatments
Combination treatments, such as topical metronidazole and oral antibiotics, can be effective in treating rosacea 5. Maintenance treatment with topical metronidazole can decrease relapses and allow for longer intervals between flares.