Rosacea: An Introduction

Ocular Rosacea Treatment

Management of ocular rosacea varies to some extent depending on the clinical manifestations.

Nonetheless, systemically administered antibiotics remain the primary form of therapy along with aggressive lid hygiene.

Both tetracycline and doxycycline have been studied clinically in the treatment of rosacea eye disease.

In a recent study of 24 patients with ocular rosacea diagnosed by both an ophthalmologist and a dermatologist, both tetracycline hydrochloride and doxycycline proved effective in the management of ocular rosacea.

In this study, tetracycline alleviated symptoms faster, while doxycycline had the advantage of easier compliance and tended to cause fewer gastrointestinal side-effects.

As for the skin manifestations, the precise mechanism of action of tetracycline in control of this disease is not clear although several hypotheses have been entertained.

As in the management of the cutaneous disease, the usual tetracycline dosage is 250 mg four times a day for three weeks initially with tapering thereafter based on clinical response.

The dosage of doxycycline is generally 50-100 mg twice daily initially with subsequent tapering.

With the exception of corneal neovascularization and healed scarring, all signs of rosacea generally respond to tetracycline beginning within two weeks after initiation of therapy.

Cessation of systemic therapy may be accompanied by relapses, and many patients require long-term, maintenance therapy.

Adjunct therapy to systemic antibiotics is important in the management of this disorder. Intensive lid hygiene with warm soaks, dilute baby shampoo, or commercially available eye scrubs will help to manage the blepharitis.

The importance of these local measures cannot be overemphasized.

Some clinicians recommend the use of a bacteriostatic ointment once daily at bedtime in addition to systemic antibiotics and lid hygiene.

The value of this topical ointment has not been verified in clinical studies. However, it does encourage patients to perform thorough lid hygiene in the morning to remove residual ointment.

Although the use of corticosteroids can be hazardous in patients with rosacea, if judiciously applied, these agents can be useful in the severe inflammatory component of the blepharitis as well as the episcleritis, keratitis, and iritis.

Patients must, however, be monitored closely, and infectious keratitis must always be ruled out prior to the use of topical steroids.

Surgical intervention may be warranted in rosacea keratitis in the case of impending or frank perforation secondary to keratitis with corneal melting.

This may include conjunctival flaps, tectonic lamellar keratoplasty, or penetrating keratoplasty.

In addition, scarring left by the disease may the indication for optical keratoplasty.

The latter should be undertaken only if the surface and lid inflammatory disease is under control.

Because of the surface disease in these patients, they are at higher risk both for post-keratoplasty surface problems as well as immune graft rejection.

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