From the Guidelines
Steroid eye drops may be used for short-term treatment of ocular rosacea to reduce severe inflammation, but their use should be limited and closely monitored due to potential serious side effects. According to the most recent study 1, a brief course of topical corticosteroids may be helpful for eyelid or ocular surface inflammation, including marginal keratitis or phlyctenules. However, the minimal effective dose of corticosteroids should be used, and long-term corticosteroid therapy should be avoided if possible.
Some key points to consider when using steroid eye drops for ocular rosacea include:
- The potential adverse effects of corticosteroid use, including the risk for developing increased intraocular pressure and cataract 1
- The use of site-specific corticosteroids, such as loteprednol etabonate, which may have a lower risk of adverse effects 1
- The importance of tapering and discontinuing corticosteroid use once inflammation is controlled, and using them intermittently to maintain patient comfort 1
In addition to steroid eye drops, other treatments for ocular rosacea may include:
- Artificial tears (preservative-free) for dryness
- Oral tetracycline antibiotics (such as doxycycline 40-100mg daily)
- Eyelid hygiene with warm compresses and gentle cleansing
- Omega-3 supplements
- Topical cyclosporine (Restasis) or lifitegrast (Xiidra) for chronic dry eye associated with ocular rosacea
It is essential to address underlying rosacea with oral medications and lifestyle modifications, and for patients to see an ophthalmologist regularly for monitoring, as ocular rosacea is a chronic condition requiring ongoing management to prevent complications like corneal damage.
From the FDA Drug Label
Loteprednol etabonate ophthalmic suspension is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitides, when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation The steroid eye drops, loteprednol etabonate, are effective for ocular rosacea because it is listed as one of the indications for use. 2
From the Research
Effectiveness of Steroid Eye Drops for Ocular Rosacea
- There is no direct evidence in the provided studies to support the effectiveness of steroid eye drops for ocular rosacea 3, 4, 5, 6, 7.
- The studies suggest that other treatment modalities, such as topical antimicrobials, oral antibiotics, intense pulsed light, and cyclosporine ophthalmic emulsion, may be effective in treating ocular rosacea 3.
- Topical azithromycin has been shown to be a novel and effective treatment for ocular rosacea, with significant improvement in symptoms and ocular signs 5, 6.
- Systemic doxycycline, particularly in a slow-release form, has also been found to be effective in treating ocular rosacea, with minimal side effects 4, 7.
Alternative Treatment Options
- Lid hygiene, artificial tears, and eyelid massage may be used in combination with other treatments to manage ocular rosacea 6.
- Intense pulsed light therapy has been shown to be effective in treating ocular rosacea, with a high response rate 3.
- Cyclosporine ophthalmic emulsion may also be used to treat ocular rosacea, particularly in cases with meibomian gland dysfunction 3.