From the Guidelines
Treatment for ocular rosacea should involve a combination of eyelid hygiene, medications, and lifestyle modifications, with a focus on controlling inflammation and preventing vision-threatening complications, as recommended by the global rosacea consensus panel 1.
Key Components of Treatment
- Daily warm compresses followed by gentle eyelid cleansing with baby shampoo or commercial eyelid cleansers to remove debris and reduce inflammation
- Artificial tears used frequently throughout the day to relieve dryness
- Oral antibiotics like doxycycline (50-100mg once or twice daily) or minocycline (50-100mg twice daily) for moderate to severe cases, usually for 6-12 weeks, due to their anti-inflammatory properties beyond their antimicrobial effects
- Topical medications such as metronidazole gel for facial symptoms, cyclosporine eye drops (Restasis) for dry eye, or steroid eye drops for short-term inflammation control
Lifestyle Modifications
- Avoiding triggers like spicy foods, alcohol, extreme temperatures, and sun exposure
- Good eye hygiene to prevent complications like corneal damage
- Consideration of ophthalmological referral for all but the mildest ocular features, as suggested by the global rosacea consensus panel 1
Additional Considerations
- The use of omega-3 fatty acid supplements may be beneficial in improving tear quality, although the evidence is conflicting, with one study showing improvement in tear film break-up time, dry eye symptoms, and meibum score 1, while another study found no significant benefit in patients with moderate to severe dry eye disease 1
- Artificial tears should be used as an adjunct to eyelid cleansing and medications, with nonpreserved tears recommended if used more than four times per day to avoid preservative-related complications 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.