Treatment of Ocular Rosacea

Abstract

Rosacea is a chronic inflammatory cutaneous disorder affecting the facial convexities including the cheeks, chin, forehead, and nose. While most commonly associated with facial rash and flushing, the majority of patients with rosacea have ocular involvement, which may even precede other facial symptoms. Ocular rosacea can result in foreign body sensation, dryness, tearing, and light sensitivity arising from eyelid inflammation, including meibomian gland dysfunction, and ocular surface inflammation. Given the current lack of definitive therapy, treatment of ocular rosacea focuses on symptom management and limiting complications. The mainstay of therapy involves aggressive lubrication with artificial tears and ointment with regular use of warm compresses to improve meibomian gland dysfunction. Lifestyle modification and dietary supplementation with omega-3 fatty acids may also play a role. For those patients with persistent symptoms, topical cyclosporine serves as an effective immunomodulator and mitigates the inflammatory response as do topical antibiotics (e.g., macrolides). Oral antibiotics, such as tetracyclines, serve to limit inflammation by targeting matrix metallopeptidases and improve signs and symptoms of the disease. Other common treatments for meibomian gland dysfunction including oral azithromycin have also been shown to be effective in the treatment of ocular rosacea. While the majority of these therapies are well-tolerated, adverse effects can range from relatively benign discomfort during instillation of eyedrops to significant complications in pregnancy. With continued research revealing the interdependence between genetic predisposition, the immune response, and autonomic and vascular dysregulation, multiple new targets for therapy have been identified, which bring with them the potential for more effective and specific therapies.