Treating Ocular Rosacea

Written by on March 22, 2006 in Ocular Rosacea with 84 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


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

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84 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. :'(

    • Jeanne says:

      Gabriel is a good makeup, natural, and no synthetic chemicals, also Ecco Bella. Turmeric, and ginger are good to take as food, or in supplement form as they are naturally anti-inflammatory. I also use organic tea bags on my eyes when they get very bad. You can use black, or green teabags, even chamomile. Just lie down with them on your eyes for 5 to 15 minutes. Good luck.

    • enid says:

      I was diagnosed 6 years ago, it was hell, had lost my eyelashes do not have it on my fact was on the doxy for 5 years, now I have a relapse..gave up wearing eye makeup but wear my gas perm contact lense very well…Clinique is the only brand I trust for mascara and I only wear on special occasions, this is a very very difficult condition to deal with daily..

  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.

    • enid luchetti says:

      don’t be nervous I was diagnosed 6 years ago, and have nothing on my face people tell me I have beautiful skin. I was told to use Ceruvue lotions I have been using Latisses for year and my eyelashes grew back, I have ocular rosacea, and dry eye and bleuprhitis all at same time

  4. 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,

    • Deb says:

      I have tried almost every type of Facial Sun screen And even the gentle ones or the ones for babies burn like crazy especially if it gets in my eyes 🙁

  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!

    • Deb says:

      I have had blepheritis For quite a few years now and the one who diagnosed mine was an ophthalmologist. I have to apply very very hot washcloth compresses to my eyes and then wash them on the inside lids With a product called ocusoft. It gets very tiresome dealing with all of this but if I slack up and don’t follow this regime on a regular basis then my eyes get so matted and miserable that I can’t see.
      Personally I recommend a good ophthalmologist to start with. Good luck

  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? ( is apparently now 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:


    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.


  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.

    • luchetti says:

      does medicare help I have one year and half before going on, my insurance is not helping much and I have suffered like hell. does medicare help with the IPL I was wondering

  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.

    • GF Dude says:

      By “heat treatments” do you mean lipi-flow? and you are not satisfied with the results?

      • Coleen B Brock says:

        GF Dude–just saw your question. I don’t know what lipi-flow is. My doctor (opthalmologist) used a machine that applied heat in short bursts to lower eyelids. He taped upper eyelids up out of the way. The bursts of heat and light were very strong. Then he took a tiny metal spoon and pressed hard on the lower lids to get rid of the oil that is like Crisco. This helped for about a month and cost $150 per treatment. I have had ten treatments. They helped but for a short time. I have not had treatments in years.

  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.

    • Patricia says:

      Yes please,any positive help to combat facial rosacea would help. This facial redness just appeared about a week ago. My referring me to a dermatologist . Hope she has some new ideas . Will reply ,after I get an appt.I also just started ,after being upset
      about this miserable covid -19 virus,with an itchy ,burning scalp,probably a neuropathy
      connection,as all other possible reasons — ruled out.
      Could both of these conditions have manifested themselves ,because of the stress factor?

  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.

    • Deb says:

      I have wondered about using colloidal silver gel? I have some in my medicine cabinet and I’m wondering if it is safe to use inside the eyes? What kind do you use? Mine is the gel that I bought from my local pharmacy over the counter

  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?

  17. Hawkeye1 says:

    First time on here today.

    Thanks to my eye dr. finally diagnosing accurately what had been a chronic condition I had been suffering from these last three years, Ocular Rosacea, combined with my own recent review of the academic research for this condition mid-December 2014- I do want this website to know, one simple treatment action, not mentioned specifically in most recommended treatment options in the research literature, that has immediately resulted in an almost complete cessation of all my symptoms.

    My dramatic relief – complete cessation of symptoms since 12/24/14 of this condition resulted from cutting off intake of any vitamin supplements containing Vitamin D.

    That, in combination with 3-times daily solute of Borax and 1% of Hydrogen Peroxide eye cleaning and face compresses has resulted in it being 95% GONE… No eye itching, no swelling of the eyelids or face, skin finally not red, and healed to like it was before this started.

    The three weeks prior to this turnaround in mid-December 2014, my condition had increased in severity, so much that I was unable to go out into public for days, due to the extreme swelling and redness, I thought I was too scary for other people to see. For this condition I had been taking as You had prescribed… doxycycline 100 mg, and erythromycin ointment, (which had diminishing effects to help me during that last bad recurrence)

    I’d be interested in hearing from Rosacea sufferers, try this simple change – and post – either way – whether they get relief – I did – Major reduction in symptoms within 3 days of cessation of taking Vitamin D supplements.

    I am available to talk about this further in detail.

    Please reference one link that helped me try that – also see Dr. Gallo’s research.

    All the Best – Hawkeye….:

  18. mary m says:

    I occasionally suffer with my eyes (minor ocular rosacea) – but the eye drops do work. I only ever got rosacea on my cheeks and across my nose. I have used the Somaluxe Redness Repair for 7 months both morning and night and I am delighted to say this stuff has completely cleared all symptoms. I use dove soap bar in the morning to wash my face and I apply the Somaluxe Redness Repair once and again before bed. I highly recommend this product and it sounds dramatic to say but its given me my confidence and life back.

  19. Comment from Chris,


    I have Ocular Rosacea, MGD but the main issue being permanently swollen upper lids

    Im under the Dry eye centre in London, and have had tee tree oil treatment, antibiotics, steroids , IPL, Lipiflow, demodex wipes , the whole works, but the eyelids never change and constantly burn and are uncomfortable. Even the eye centre say they can always feel the heat off them, when they use the slit lamp.

    Do you know any success stories for reducing inflammation of the lids? although i don’t have many MGD glands left , probably less than half, i don’t really have a dry eye problem. Just the swelling. Im 51 and had blepharitis all my life, but over the last 5 years has got worse.

    I’m currently taking metronozidale tablets and once a week Ivermectin tablets, which i read killed the parasites and the bacteria with a good success rate.

    The Ivermectin tablets aren’t available by NHS prescription in the UK, so i ordered them direct from a Pharmacy company.

    to date the combination has had no affect

    many thanks

    • Joe says:

      Especially see the final sentence I have posted, which was what prompted my relief….

      I had been suffering from these last three years, Ocular Rosacea, combined with my own recent review of the academic research for this condition, I do want folks to know, one simple treatment action, not mentioned specifically in most recommended treatment options, that has immediately resulted in an big reduction of all my eye lid inflammation eye swelling, etc. symptoms.

      My dramatic relief – almost complete cessation of symptoms since 12/24/14 of this condition resulted from cutting off intake of any vitamin supplements containing Vitamin D.

      That, in combination with 3-times daily eye treatment (using a paper towel wrapped around an ice cube treated with the solution of…) solute of equal volume of Borax and 5% (so the peroxide ends up at 2 to 2-1/2 % ) of Hydrogen Peroxide eye cleaning and face compresses has resulted in it being 90% GONE… No eye itching, no swelling of the eyelids or face, skin finally not red, and healed to like it was before this started.
      The three weeks prior to this turnaround in mid-December, my condition had increased in severity, so much that I was unable to go out into public for days, due to the extreme swelling and redness, I thought I was too scary for other people to see.

      Please reference link: my research I found…

      I spent a few days web-searched all the available online research about Rosacea and specifically the skin peptides, including the cathelicidins, and found that EXTRA doses vitamin D-3 Helped those with skin conditions that resulted from relatively inactive cathelicidins, e.g. see Dr. Gallo’s research.

      Despite not finding any research treatment recommendations specifically for Ocular Rosacea relating to Vitamin D, and D-3, I did find research that other skin conditions that have resulted from the above inactive peptides, my logic was the opposite (cessation of Vitamin D intake) may help if the cathelicidins are TOO active, this has worked for me – at least these last 3 weeks….

      see…link – and especially the last sentence of excerpt below…
      “Understanding the role of antimicrobial peptides in mammalian immunity is complicated by many observations that these peptides also act on the host to stimulate a variety of important responses related to defense against injury. Cathelicidins were first found in mammalian skin due to their ability to increase fibroblast proteoglycan synthesis (34). Defensins and cathelicidins have both been shown to have chemotactic activity, possibly functioning through specific receptors, such as CCR6 or formyl peptide receptor-like-1, respectively (21, 35). Consistent with these prior observations, LL-37 was found in the present study to be a potent stimulus for IL-8 release from cultured keratinocytes. This effect was diminished upon processing to RK-31 or KS-30 and was almost completely eliminated in the shortest KR-20 cathelicidin. It is not clear whether topical LL-37 secreted into sweat would have a similar effect in vivo on epidermal keratinocytes when separated by the formidable barrier of the stratum corneum. However, the inhibition of proinflammatory functions by LL-37 in normal epithelia would be a beneficial mechanism to regulate unintended inflammation.”

      However, the inhibition of proinflammatory functions by LL-37 in normal epithelia would be a beneficial mechanism to regulate unintended inflammation.”

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