From the Guidelines
To treat upper eyelid rosacea, also known as ocular rosacea, start with gentle daily eyelid hygiene, applying warm compresses to your closed eyelids for 5-10 minutes, then gently cleaning the eyelid margins with diluted baby shampoo or commercial eyelid cleansers. This approach is based on the most recent and highest quality study available, which emphasizes the importance of eyelid hygiene in managing symptoms of blepharitis and ocular rosacea 1. Key components of the treatment include:
- Warm compresses to soften adherent scurf and scales or discharge and/or warm the meibomian secretions
- Eyelid cleansing, which can be accomplished by brief, gentle massage of the eyelids or using eye cleaners with hypochlorous acid at 0.01%
- Artificial tears to help with dryness, with preservative-free options recommended 4-6 times daily
- Topical medications such as metronidazole 0.75% gel or oral antibiotics like doxycycline 40-100mg daily for 6-12 weeks for moderate to severe cases It is also crucial to avoid potential triggers, including hot beverages, spicy foods, alcohol, extreme temperatures, and harsh skincare products, and to use gentle, fragrance-free skincare products and always wear sunscreen 1. Ocular rosacea is a chronic condition that requires ongoing management, and consistent treatment is essential to control symptoms like redness, burning, and irritation. The treatment should be tailored to the individual patient's needs and severity of symptoms, and may involve a combination of these approaches. By following this treatment plan and making lifestyle adjustments, patients can effectively manage their upper eyelid rosacea and improve their quality of life.
From the Research
Treatment Options for Blepharal Rosacea
- Topical metronidazole, sulfacetamide/sulfur, and azelaic acid are generally effective for patients with mild rosacea, including blepharal rosacea 2, 3, 4
- For moderate papulopustular rosacea, combination therapy with oral tetracyclines and topical agents is the first-line choice 3, 4
- Patients with ocular involvement, including blepharal rosacea, may benefit from long-term oral antibiotics and metronidazole gel 4, 5
- Treatment options for ocular rosacea, including blepharal rosacea, include lid hygiene, topical and oral antibiotics, cyclosporine ophthalmic emulsion, oral vitamin A derivatives, and intense pulsed light 5
Specific Treatments for Blepharal Rosacea
- Topical antimicrobials, such as metronidazole, achieved a complete or partial response in 91% of patients with ocular rosacea, including blepharal rosacea 5
- Oral antibiotics, such as doxycycline, achieved a complete or partial response in 89% of patients with ocular rosacea, including blepharal rosacea 5
- Subantibiotic dose oral doxycycline 40 mg modified-release capsules once daily can reduce the relapse rate and inflammatory lesion counts in subjects with moderate-to-severe inflammatory rosacea, including blepharal rosacea 6
Combination Therapies
- Combination treatment with oral antibiotics at both antimicrobial and subantimicrobial doses is an efficacious means of treating rosacea, including blepharal rosacea 2, 3, 6
- Combination treatments, including topical and oral antibiotics, achieved a complete or partial response in 90% of patients with ocular rosacea, including blepharal rosacea 5