From the Guidelines
Treatment for ocular rosacea typically involves a combination of eyelid hygiene, artificial tears, and medications, with oral antibiotics like doxycycline (50-100mg daily) or minocycline (50-100mg twice daily) prescribed for 6-12 weeks, as they have anti-inflammatory properties beyond their antimicrobial effects, as supported by recent studies 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
- Preservative-free artificial tears used frequently throughout the day to lubricate the eyes
- Topical medications such as cyclosporine eye drops (Restasis), azithromycin eye drops, or metronidazole gel for the face
- Brief courses of topical steroids under ophthalmological supervision for severe cases
Additional Considerations
- Avoiding triggers like spicy foods, alcohol, extreme temperatures, and harsh skincare products
- Omega-3 fatty acid supplements to help reduce inflammation
- Wearing sunglasses outdoors and maintaining good overall skin care
Recent Evidence
Studies have shown that doxycycline is effective in reducing inflammatory lesions and perilesional erythema associated with rosacea 1, and that oral antibiotics can provide symptomatic relief and improve tear break-up time in patients with rosacea and meibomian gland disease 1.
Treatment Approach
A comprehensive approach addressing both bacterial overgrowth and inflammatory components of ocular rosacea is recommended, providing symptomatic relief and preventing potential corneal complications, as supported by recent guidelines and studies 1.
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