From the Guidelines
Treatment for ocular rosacea typically involves a combination of eyelid hygiene, artificial tears, and medications, with oral antibiotics like doxycycline being a common prescription for moderate to severe cases, as they have anti-inflammatory properties beyond their antimicrobial effects 1.
Key Components of Treatment
- Daily eyelid cleaning with warm compresses and gentle cleansers to remove debris and reduce inflammation
- Preservative-free artificial tears used throughout the day to relieve dryness and irritation
- Oral antibiotics such as doxycycline (50-100mg once or twice daily) for 6-12 weeks for moderate to severe cases, due to their anti-inflammatory properties 1
- Topical medications like metronidazole gel applied to the eyelids or cyclosporine eye drops (Restasis) for severe dry eye symptoms
- Topical steroids for short-term use in flare-ups, but avoiding long-term use due to side effects
- Avoiding triggers such as spicy foods, alcohol, extreme temperatures, and harsh skincare products
- Omega-3 fatty acid supplements to help reduce inflammation
Rationale and Evidence
The treatment approach is based on controlling inflammation, improving meibomian gland function, and addressing bacterial overgrowth that contributes to symptoms like redness, burning, and irritation. Studies have shown the efficacy of oral doxycycline in reducing inflammatory lesions and improving symptoms in patients with rosacea 1. Additionally, topical metronidazole has been found effective in reducing inflammatory lesions and perilesional erythema associated with rosacea 1. The use of artificial tears and eyelid hygiene measures is also supported by evidence as beneficial for managing dry eye symptoms and reducing inflammation 1.
Considerations and Precautions
It's crucial to use the minimal effective dose of corticosteroids and avoid long-term use due to potential side effects such as increased intraocular pressure and cataract formation 1. Patients should be informed about these risks and the importance of adherence to the prescribed treatment regimen. Regular follow-up is necessary to monitor the response to treatment and adjust the therapeutic plan as needed.
From the Research
Treatment Options for Ocular Rosacea
- Topical antimicrobials, oral antibiotics, intense pulsed light, and cyclosporine ophthalmic emulsion are the most effective treatment modalities for ocular rosacea, achieving complete or partial response in 91%, 89%, 89%, and 87% of patients respectively 2
- Lid hygiene is also a treatment option, with a complete or partial response in 65% of patients 2
- Combination treatments can achieve a complete or partial response in 90% of patients 2
Systemic Treatment
- A sub-antimicrobial dose of slow release doxycycline 40 mg daily is an effective long-term therapy for ocular rosacea, with no side effects reported 3
- Systemic doxycycline is also effective in treating ocular rosacea, with a significant improvement in symptoms and ocular signs 4
Topical Treatment
- Topical azithromycin may represent an additional treatment for ocular rosacea, with a shorter duration of treatment and absence of gastrointestinal side effects as compared to systemic doxycycline 4
- Cyclosporine 0.5% ophthalmic emulsion is significantly more effective than artificial tears for treating ocular rosacea 5