A brief but quite well written article about Treating Ocular Rosacea from the American Academy of Ophthamology’s EyeNet Magazine online. This paper gives the high level approach of how to get ocular rosacea under control.
How to Treat Ocular Rosacea, Roger M. Kaldawy, MD, John E. Sutphin, MD, And Michael D. Wagoner, MD. Edited By Sharon Fekrat, MD, And Ingrid U. Scott, MD, MPH
Pathophysiology
Tear film disturbances are responsible for the vast majority of subjective complaints and objective findings in ocular rosacea. The reduced amount and altered character of meibomian gland secretions result in destabilization of the lipid portion of the tear film and increased tear evaporation rates. More than one-third of patients with rosacea also have impaired aqueous tear secretion, further contributing to ocular surface desiccation.
The most serious complications of ocular rosacea probably result from reactions of the sclera, limbus and cornea to staphylococcal endotoxins or cell-mediated hypersensitivity responses to staphylococcal antigens. The variability in response of patients with ocular rosacea to these immune reactions may account for the extreme variability in clinical signs and symptoms associated with this disorder.
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Drug Treatment
Tetracycline derivatives are the mainstay of therapy for ocular rosacea. Our standard regimen is to start with 100 milligrams of doxycycline orally twice a day for one month, after which it is used once daily for at least two more months.
Therapeutic response. Patients are advised that there will be a delayed therapeutic response of several weeks. At three months, the medication is adjusted according to the therapeutic response: For marked improvement, the medication can be tapered to 100 mg every other day for the next three months. For mild to moderate improvement, 100 mg is continued on a daily basis. After six months, patients may go on “doxycycline vacations” for two to three months. Eventually symptoms will recur in most cases, and periodic reinstitution of low maintenance doses is necessary.
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Three-Step Approach
Tetracycline derivatives are most effective when used in conjunction with the following three-step approach:
- Normalize tear film disturbance.
- Warm compresses. These help further minimize meibomian gland obstruction and improve lipid flow into the tear film.
- Punctal occlusion. Temporary or permanent occlusion is useful if aqueous tear production is deficient.
- Artificial tear substitutes. These are useful until ocular surface wetting, punctate epitheliopathy and variable vision during prolonged visual tasks have improved.
- Control bacterial overgrowth.
- Lid hygiene. This is part of a long-term maintenance program to minimize meibomian gland obstruction, improve lipid flow into the tear film and control bacterial overgrowth.
- Topical antibiotics. These are useful in the first month of treatment to reduce bacterial flora. Generally, they should be used when acute mucopurulent blepharoconjunctivitis, marginal corneal infiltrates or peripheral ulcerative keratitis are present.
- Control inflammatory and hypersensitivity reactions.
- Topical corticosteroids. These are useful in the first month of treatment to reduce ocular surface inflammation. Generally, they should be used if marginal corneal infiltrates, peripheral ulcerative keratitis without progressive thinning and/or vascularization are present.
- Topical progestational steroids. Compounded medroxyprogesterone 1 percent may be used if peripheral ulcerative keratitis with progressive thinning is present.
In addition, topical progestational steroids are useful in conjunction with corticosteroids for treating progressive vascularization.
- AAO EyeNet: Treating Ocular Rosacea
18 comments ↓
Greetings: I have been taking 100 mg of doxcycline for over 2 months now for ocular rosacea, however, I am having terrible heartburn because of it & this eye infection seems to be extremely persistent. My doctor recommends that I continue taking doxcycline for another 3 months. AARRGGG…There has to be a better way….
I just read this and am now going through the same
thing. I have been on and off of the doxy and now the
doctor switched me to flagl? What result did you have
finally??
ROse
Hi Maria and Rose,
perhaps it might be worthwhile asking your doctor if a low dose doxycycline, say Oracea or generic doxycycline 50mg a day is an alternative. This dose is much less likely to cause a reaction, and should still give a good benefit if you continue for a few months.
davidp.
I’ve been taking 200 mg Doxy daily (100 mg twice a day) for occular Rosacea and Rosacea pimples (I’m using laser for redness and flushing). It’s been a week so far, so I’m not expecting results yet. If you’ve had good results with antibiotics on any Rosacea symptoms, please email me at lapuskas@yahoo.com. Thanks.
Hi Lauren, you will need around 4-6 weeks on doxy to see the full benefit of taking it.
Thank you so much for your information. My brother, Daymon has had an inherited eye desease, lattice dystrophy. The doctor has been treating him for a transplant rejection, an infection but at the most recent visit he thinks he may have rosacea. He seems to be really in trouble with his eye situation. Any helpful information would be much appreciated.
Hi Carl,
Sorry but I have no idea bout lattice dystrophy. I don’t recall it ever coming up on any of the rosacea boards and I couldn’t find anything by doing a search. We wish you all the best.
davidp.
i have recently been diagnosed with lattice dystrophy, and I have suffered from ocular roscea for years. I have always believed that there was a connection. I have used baby shampoo and tea tree shampoo for treatment. I have had periodic relief from the roscea using these products. Any comments?
I need to locate a specialist the treats Ocular Rosacea. We live in San Francisco, CA but will travel to find the BEST Doctor. Can you recommend a Doctor?
Your help is much appriciated,
Norman
Hi Norman,
I think the idea of a best doctor may well be one of those concepts that are hard to pin down and may even consume and waste time – most especially because best will be a personal perception.
I haven’t sought out a doctor for ocular rosacea myself but I do know of a couple of doctors that have been very helpful to the online rosacea community.
Dr. Eric Jones, MD from the Devers Eye Institute in Portland, Oregon gave us a nice interview here: Ocular Rosacea: Dr. Eric Jones, MD as well as Ocular Rosacea: Dr. Mark J. Mannis, MD.
Dr. Mannis is an experienced Opthamologist Department of Ophthalmology & Vision Science at the University of California, Davis – closer to you. I don’t know if he still se patients, but that might be worth investigating also.
You might also find some helpful people hanging out in the Ocular Rosacea Community forum.
Hope this helps,
davidp.
Hi David,
I have had rosacea for several years, under control now, thank goodness, but I now realize from reading on this website (many thanks!) that my eye problems are ocular rosacea! However, as a sufferer rather than a medical practitioner, I am having a great deal of trouble understanding the terminology.
Could you please translate the above “Treating Occular Rosacea”. I have a medical dictionary in one hand and Google up on another tab. Still cannot find “punctate epitheliopathy” or “punctal occlusion” or “mucopurulent blepharoconjunctivitis”. Give me a break! I need to know what these are and what I can do about them or if I even have them!
I do understand about warm compresses and artificial tears and can start with those immediately to help alieviate some symptoms.
Thanks for all the help and the realization that I am not alone in this.
Terry
Hi Terry,
OK I’m no Opthamologist, you might have a better chance with your text books, but let me have a try.
Punctal Occlusion
This is the easy one. The punctual plugs are where the tears drain out of the eye – in the corners of the eye towards the nose. If the eyes are not wet enough from your own tears, a doctor may put a plug into the `drain’ to slow the exit of tears.
Punctate Epitheliopathy
An epithelium is the covering of the eye, so this sounds like a disease of the epithelium seen as small holes or elevations on the surface.
Mucopurulent Blepharoconjunctivitis
At a guess I’d say a form of blepharitis/conjuctivits where mucus and pus are present. The conjuctiva is of course one of the protective layers of the eye. Blepharitis is inflamation of the eyelid margins. So it sounds like a condition where the eyelid and eye surface is involved and pus/mucus is being produced.
I’d be happy for corrections !
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I have been diagnoised with Morgellons disease and have been searching the internet for two years. I believe this is the connection.
I AM 49 AND SUFFERED SINCE I WAS 14 WITH EYE REDNESS, BLOODSHOT AND DRY. I WAS UNDER AN OPTOMOLOGIST CARE SINCE I WAS 17. I DIDN’T KNOW WHAT I HAD AN NO DOCTOR GAVE ME A SPECIFIC DIAGNOSIS UNTIL LAST YEAR. I WAS TREATED FOR BLEPHARITIS, CONJUNTIVITIS, DRY EYE AND ALLERGIES. I WAS GIVEN TOPICAL ANTI-INFLAMMATORIES, STEROIDS AND ANTIBIOTICS. I WAS GIVEN ARTIFICIAL TEARS, EYE WASHES AND CLEANSERS. SOME BROUGHT MARGINAL RELIEF AND OTHERS DID NOTHING. I WAS ON A STEROID DROP FOR OVER 15 YEARS AND WAS LUCKY ENOUGH NOT DEVELOPE CATARACTS OR GLAUCOMA BECAUSE OF THE LENGTH OF MY STEROID USE.
I HAVE SUFFERED EMOTIONALLY BECAUSE OF THIS WITH PEOPLE THINKING I WAS A DRUGGIE, ALCOHOLIC OR BOTH. I WAS INSECURE AND STILL AM ABOUT IT. THE WORST THING ABOUT ALL OF THIS IS THAT I HAVE BIG EYES SO IT MAKES IT MORE VISIBLE. IF I HAD BEADIE EYES I MAY HAVE BEEN ABLE TO HIDE IT A LITTLE BETTER.
ANYWAY, I SOMEHOW SURVIVED IT ALL AND MANAGED TO ALWAYS BE SOCIALLY ACTIVE BUT IT WASN’T EASY. I DID LET IT GET TO ME AT TIMES AND OTHER TIMES I WOULD JUST SAY HELL WITH IT AND IF YOU HAD SOMETHING TO SAY I WOULD JUST LET YOU HAVE IT.
IT IS NOT AN EASY THING TO LIVE WITH AND I NO HOW DEPRESSING IT CAN BE TO DEAL WITH IT AND THE SOCIAL IMPLICATIONS.
DON’T LET IT DESTROY YOUR HAPPINESS. THE BEST WAY TO DEAL IS TO LET PEOPLE KNOW WHAT YOU HAVE WHEN THEY MAKE A COMMENT TO YOU. MOST OF THE TIME THEY WON’T BUT YOU CAN FEEL THEM STARING AT YOU.
IT HAS ONLY BEEN RECENTLY I MET A DOCTOR WHO DIAGNOSED IT CORRECTLY. I TAKE RESTASIS TWICE A DAY, ARTIFICIAL TEARS TWICE A DAY AND A DISOLVING TABLET I PLACE IN MY EYE TWICE A DAY CALLED LUCIVERT. I ALSO HAVE PLUGS TO CONTROL MY TEAR DRAINAGE.
ALL I CAN SAY IS A GOOD PERSONALITY WILL GET YOU THROUGH. I HAVE ALWAYS BEEN THE JOKER AND LIFE OF THE PARTY AND THAT HAS HELPED ME SURVIVE.
IF ANYONE NEEDS SOMEONE TO TALK TO ABOUT THIS CONTACT ME ANYTIME AT MY EMAIL.
BRONXBOYMARK@AOL.COM
My husband has this eye problem for about 4 years. He has been to eye specialists who said that his eyes were oily and has recomended blepharitis gel for cleaning the eyelids and we have also tried warm compress. One of hte eye specialists recommended retasis which my husband has tried but only for a month and give up as there is not much improvement. He told me his eyes felt gelly and he has oily face. I will cleanse his eyelids with the blepharel gel thrice a day but still not much improvemnt. Glad to hear from your experience about what treatment you have. Thanks and look forward to receiving a response from you.
Comment via email:
“hi catherine:
i can only tell you that there are occasionally days where they feel and look better. i have had this for my entire life and have learned to live with it. washing my eyelids helps a little but it is a frustrating thing. people don’t understand that it is not only a cosmetic thing but a physical pita.lol. my eyes feel like there is sand in them, they hurt, they itch and they strain easily. other than that, it’s great! lol. you kind of get use to the redness and bloodshot eyes but you feel very insecure and self-conscious. the thing is drug companies have come up with drugs to grow eyelashes, tighten skin and improve your love life but nobody seems to be doing anything for this serious and uncomfortable ailment. I never realized there were so many millions of people suffering with rosacea. I don’t and never has rosacea on my skin but have had eye rosacea for 35 years. Go figure.\Well tell your husband to keep the faith. Eye refeshing tear drops help as do eye compresses.
write me anytime.
Mark”
I believe this is all related to H Pylori.
I too have rosacea and chalazian of the eye,
Do any of you guys also suffer heartburn, bloating etc.
I DO NOT believe Doctors know what they are doing,
I do believe that we are all chemically inbalanced and the toxins from H Pylori are released through our skin and or eyes, And our only cure will be treating The H Pylori.
Wow! I am so happy to find this site. I have had rosacea for years and used creams and oral antibiotics. More than 2 years ago I experienced eye pain and redness for the first time. That has resulted in many MD appointments and different diagnosis and treatments to no avail. I do the eye scrubs, eye lubricant drops, ointments, oral antibiotics, eye drops with antibiotics and steroids, and for the last six week restasis. The restasis seems to be more irritating than helpful. I have discontinued the restasis as of today. The redness I can live with but the pain and decreased vision acuity is trying! It’s nice to hear that I’m not alone! Kind of misery loves company! If anyone has any new ideas I’d love to hear them.
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