Treating Ocular Rosacea

Written by on March 22, 2006 in ocular rosacea with 66 Comments

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.

….

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.

….

Three-Step Approach

Tetracycline derivatives are most effective when used in conjunction with the following three-step approach:

  1. 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.
  2. 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.
  3. 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.

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About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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66 Reader Comments

  1. Monica says:

    I have ocular rosacea but still want to wear eye makeup. By the evening my eyes can feel like oil slicks. A friend without rosacea recently had permanent eyeliner applied – basically a tattoo. Does anyone have experience with this? Any advice?

  2. Kathy says:

    I have ocular rosacea and I would also like to wear eye makeup. I would appreciate it if any of you have found an eye makeup that does not irritate. Also I would really like to be able to wear contact lenses again. Have any of you had experience with wearing contacts and also having ocular rosacea. I am currently on 200 mg of doxycycline a day with not much success. I have a flare-up of my ocular rosacea about avery 10 days. Any information would be greatly appreciated. Thank you.

    • brooke says:

      I used to use Mac before I got perminent eyeliner. It was the only thing that did not set my eyes on fire. Currently I am unmanaged due to pregnancy. :'(

  3. Amanda says:

    I was just diagnosed with ocular rosacea. Does this eventually lead to rosacea symptoms on the face? I am getting very nervose reading everything out there.

  4. David Pascoe says:

    Hi Amanda,

    There is no direct association between ocular symptoms and facial symptoms. Many will have one or the other, and others both.

    Not enough is known about rosacea to say who will develop what types of rosacea at what times.

    If you don’t already have facial symptoms then that is a good sign.

    Some treatments for ocular rosacea will also help facial rosacea, so that is also good news.

    As a preventative measure you want to consider if there is anything you can do to reduce facial flushing if you suffer from them. Also the use of a gentle skincare regime and daily physical sunscreen is another good item to keep in your war chest.

    The internet is a great resource for almost all diseases, but especially for rosacea it can be scary to read the worst case scenarios all the time. People do get better from rosacea.

    all the best,
    davidp.

  5. T. Grey says:

    H. Pylori

  6. Liam Yurman says:

    I have struggled for 20 years with red swollen eyelids and have been diagnosed with either ocular rosacea or blepharitis, or possibly both. Doctors haven’t been able to figure out the problem or alleviate any of the redness and don’t consider it important because it’s mainly cosmetic. I have had laser treatments on the eyelids which help temporarily, but the redness returns after a month or so. I was ready to go in for another treatmen,t but decided to do some research on the internet and found a product that actually works!! I have only been using it 2 days and the redness has decreased by 60-80%!! Its only 2 days, so we’ll see how it progresses, but I felt a responsiblity to share this information because I know how embarrasing and humiliating this condition can be. The product is inexpessive, less than $20, and is sold at department stores or lots of sites on the internet: Mario Badescu Healing Cream. I apply this directly to the lids without any sort of irritation. I will continue to update everyone on the progress. Good luck and God Bless…

    • Elaine Bales says:

      I can’t find marci badesco healing cream. Is it eye healing cream or face healing cream? On the internet I found smoe for $119.00. Where can I get some? Please advise.

    • lee says:

      which healing cream did you get, there are different ones ?

    • Bonny says:

      This cream has been discontinued and there is a lawsuit over it. It contained hidden corticosteroids which are bad for delicate facial skin!

  7. Irene McDonald says:

    I suffered from ocular rosacea for years but thought it was a sinus related problem. I used all the wrong eye drops which made it worse. Keep away from the anti histamine types. They dry the eyes out badly.

    No more tears or Systane are fine and gentle. For long term relief Cod Liver oil capsules are good. I take 3 or 4 a day. They oil from the inside out and provide some Vitamin A.

    I also had chalazion which looked like a stye that wouldn’t come to a head for over 9 months. A clinical optometrist who had done a study on this problem suggested gently cleansing both lids and applying a tiny amount of Manuka honey each day. The chalazion was gone in days and has never come back. In Australia and New Zealand Manuka honey in tubes is freely available in pharmacies and health food stores. Buy medical grade not food grade.

    Eye makeup is not a problem to use anymore but I stick to good minerals.

    Lots of research and trials can get you ahead of Rosacea without antibiotics and prescription products.

  8. Timothy says:

    What kind of luck has anyone had with Panoptx eyeware or sunglasses with the faom shields to prevent tear evaporation? (Panoptyxpro.com is apparently now http://www.7eye.com). They are pricey, but my eyes are affected by both wind and bright sunlight, they may be worth the price. I see you can order them with prescription lenses also, which is probably really pricey.

  9. david says:

    Irene,

    I see you have experience with occular rosacea which i think i have recently started to contract due to this annoying disease.

    In your experience, do you think it is worth while going to a specialist or a doctor? I realise it is difficult to give this sort of advice, but the general consensus seems to be that it has been a waste of money.

    I have a good supply of doxycicline at home and may take your advice on cod liver oil capsules. I’ve just upped my intake of fish oil, have started my warm compresses.

    I just can’t believe i am getting this as well as facial rosacea.

    D

  10. Irene says:

    Hi David

    I would not like to advise you re going to a doctor but my faith in that area is very low with anything to do with Rosacea.

    As I mentioned it was a clinical optometrist who suggested applying Manuka honey for chalazions. Over the holiday period I stopped taking Cod liver oil with A and D and found the dry eyes returned.

    I do not and will not take medication for Rosacea. A good doctor who does IPLL fixes the redness and broken capillaries. You can get substantial rebates from Medicare through some clinics – ask the question so it doesn’t break the bank.

    You can overcome this awful condition.

    • JL says:

      Irene, can you tell me what IPLL stands for. My main complaint is redness and burning of the eyes.

    • Anne says:

      You will take medication if the rosacea affects your eyes! Guaranteed!
      IPL works great on the face, but I can’t get anyone to help with the cost.

  11. Carol says:

    I have recently been diagnoised with rhinophyma. What is the best treatment for this?
    I have had laser treatment for the redness on my nose and cheeks, but there are still
    little bumps there. I have been using anti-biotic cream on my face and taken orally, but it doesn’t look like it is improving. Now my eyes are tearing, red and swollen eyelids. I just don’t know where to start for treating this and what kind of treatment is best. I certainly don’t want to end up with a distorted nose.

  12. Coleen Brock says:

    I have ocular rosacea and blepharitis. I have used Ocu-Soft with some good results. I have tried a 50% solution of tea-tree oil–could hardly stand the burn and after six weeks, discontinued. I am unable to tolerate eye gels or eye ointments, both of which contain petroleum derivatives and mineral oil. I have found Steri-Lid recently-a foam that has some tea tree oil in it. It is easy to use and has helped a great deal to diminish dry crummy matter on my eyelids at night. I still use dry-eye drops with some success. I have had heat treatments in the past which help temporarily.

  13. kim says:

    HELP. what can help with the inflammation- redness of the eye.

  14. Sheila says:

    I was given a prescription that set my lids on fire. I stopped washed with warm water and applied organic virgin coconut oil because I had nothing else to soothe my eyes. The pain stopped and I could sleep. I am still using this at night. Try it and see if it helps you. I am searching for natural ways to manage this because I have both facial rosacea and ocular. If anyone out there has used anything that helped, please reach out to those of us who are newly diagnosed.

  15. Barb says:

    I have been diagnosed with ocular rosacea in 2008 and have been given the prescription of tetracycline. It caused severe yeast infections and only gave me about 50% relief at most with steady use. I have been using Colloidal Sivler gel for since 2009 and have had 100% relief. I do not have blue skin what so ever. I apply the jel to my eyelids after a thorough wash once or twice a day. That is it. And it has completely changed my quality of life. Doctors only have drugs to offer. This is a natural anti-microbal treatment.

    • JL says:

      Barb, does the colloidal silver gel help with redness and burning of your eyes? Where do you get it? Which brand?

      • Jen says:

        The only brand I know to be truly the best is by Sovereign Silver. Try to get the one with the smallest parts per molecule, even if it is a bit expensive. The one with 10 ppm is fine.

  16. Ellen says:

    I’ve been struggling for 2 years and its getting worse. I don’t want to take antibiotics. Eyes are always red and swollen and at times water so bad it feels like I’m crying. Looks like I found this site a little later than everyone else. Does the the cod liver capsules still work with the Manuka honey?

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