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Practice Patterns and Clinician Opinions for Treatment of Ocular Rosacea

Gurbani Kaur
, 
Travis K. Redd
, 
Gerami D. Seitzman
Publication type: Journal Article
Publication date: 2022-09-30
Journal: Cornea
scimago Q1
wos Q2
SJR: 1.019
CiteScore: 5.2
Impact factor: 1.9
ISSN: 02773740, 15364798
Ophthalmology
Abstract
Management of ocular rosacea is challenged by the limited evidence-based systemic treatment guidelines and lack of elucidated mechanisms of treatment efficacy.We conducted an online survey of clinicians who regularly treat ocular rosacea to elicit their opinions on treatment algorithms and understanding of the treatment's primary mechanism of action. Descriptive statistics and univariate comparisons were reported.One hundred thirty-two participants completed the online survey. Of the 132 respondents, 74% were cornea specialists. Most respondents (85%) favored systemic tetracyclines over macrolides. Providers' specialty training did not significantly influence preference between tetracyclines and macrolides for ocular rosacea management. Among tetracycline prescribers, there was no consensus regarding initial dosage and duration prescribing patterns. Most macrolide prescribers (88%) initiated a 3-week course of 1 gram of azithromycin weekly. Long-term management strategy for treatment-responsive patients varied: 46% preferred to half the initial dose, 29% discontinued pharmacotherapy, and 16% chronically pulse-dosed patients. Most tetracycline prescribers (90%) and macrolide prescribers (73%) postulate their chosen agents' primary mechanism of effect for ocular rosacea is anti-inflammatory. However, there was no consensus in identifying anti-inflammatory doses of either drug class. Furthermore, there is discordance between prescribers' intended mechanistic effect with the selection of initial dosages for both tetracycline and macrolides for ocular rosacea.Among clinicians who commonly treat ocular rosacea, there is significant community equipoise regarding which dose of tetracycline is best for initial systemic treatment of this disease. In addition, a consensus understanding regarding mechanism of action of this treatment is lacking.
Found 14
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Wiley
Ocular manifestations of rosacea: A clinical review
Tavassoli S., Wong N., Chan E.
Clinical and Experimental Ophthalmology scimago Q1 wos Q1 , 
2021-02-03,  citations by CoLab: 37 ,  Abstract  
Ocular rosacea is a chronic inflammatory condition that can occur in the absence of cutaneous features. The most common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring and, rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. It can also be associated with systemic disorders such as cardiovascular disease. Management ranges from local therapy to systemic treatment, depending on the severity of the disease. In this review, we describe the epidemiology, pathophysiology, clinical features and treatment of rosacea and ocular rosacea.
Elsevier
Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee
Gallo R.L., Granstein R.D., Kang S., Mannis M., Steinhoff M., Tan J., Thiboutot D.
Journal of the American Academy of Dermatology scimago Q1 wos Q1 , 
2018-01-01,  citations by CoLab: 317 ,  Abstract  
In 2002, the National Rosacea Society assembled an expert committee to develop the first standard classification of rosacea. This original classification was intended to be updated as scientific knowledge and clinical experience increased. Over the last 15 years, significant new insights into rosacea's pathogenesis and pathophysiology have emerged, and the disorder is now widely addressed in clinical practice. Growing knowledge of rosacea's pathophysiology has established that a consistent multivariate disease process underlies the various clinical manifestations of this disorder, and the clinical significance of each of these elements is increasing as more is understood. This review proposes an updated standard classification of rosacea that is based on phenotypes linked to our increased understanding of disease pathophysiology. This updated classification is intended to provide clearer parameters to conduct investigations, guide diagnosis, and improve treatment.
Wiley
Epidemiology of rosacea in Colombia
Rueda L.J., Motta A., Pabón J.G., Barona M.I., Meléndez E., Orozco B., Rojas R.F.
International Journal of Dermatology scimago Q1 wos Q1 , 
2017-02-27,  citations by CoLab: 27 ,  Abstract  
Prevalence of rosacea has been estimated around the world in the range of 0-22%. In Colombia, the prevalence of rosacea remains unknown. The aim of this study was to determine the prevalence of rosacea and the frequencies of its subtypes in Colombia.This cross-sectional, multicenter study was conducted in six outpatient dermatology clinics across Colombia. A total of 33 dermatologists conducted a comprehensive medical history and physical examination for all rosacea patients seen at their offices over the course of 2 months. All patients who accepted to participate were encouraged to answer a survey about the history of their illness.Of 10,204 outpatients evaluated for rosacea between July and August 2014, 291 rosacea patients were included in this study. The prevalence of rosacea subtypes in this cohort was: 45.3% erythematotelangiectatic (ETR) (n = 132), 48.7% papulopustular (PPR) (n = 142), 4.8% phymatous (n = 14), and 1% ocular (n = 3).Overall, the prevalence in Colombia was 2.85%. Our data represent an important first step to understanding the current state of rosacea in Colombia. The prevalence of rosacea in Colombia is the highest in Latin America among a few reports published, which might be explained by geographic features. However, contrary to our expectations, the prevalence is lower than that in some European countries. We postulate that this finding may be due to methodological differences.
Taylor & Francis
Rosacea: Epidemiology, pathogenesis, and treatment
Rainer B.M., Kang S., Chien A.L.
Dermato-Endocrinology , 
2017-01-01,  citations by CoLab: 131 ,  Abstract  
Rosacea is a chronic relapsing inflammatory skin disease with a high prevalence among adults of Northern European heritage with fair skin. Symptoms present in various combinations and severity, often fluctuating between periods of exacerbation and remission. Based on morphological characteristics, rosacea is generally classified into four major subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. Diverse environmental and endogenous factors have been shown to stimulate an augmented innate immune response and neurovascular dysregulation; however, rosacea's exact pathogenesis is still unclear. An evidence-based approach is essential in delineating differences between the many available treatments. Because of the diverse presentations of rosacea, approaches to treatment must be individualized based on the disease severity, quality-of-life implications, comorbidities, trigger factors, and the patient's commitment to therapy.
Wiley
Prevalence of rosacea in the general population of Germany and Russia – The RISE study
Tan J., Schöfer H., Araviiskaia E., Audibert F., Kerrouche N., Berg M.
Journal of the European Academy of Dermatology and Venereology scimago Q1 wos Q1 , 
2016-02-24,  citations by CoLab: 94 ,  Abstract  
There is an unmet need for general population-based epidemiological data on rosacea based on contemporary diagnostic criteria and validated population survey methodology.To evaluate the prevalence of rosacea in the general population of Germany and Russia.General population screening was conducted in 9-10 cities per country to ensure adequate geographic representation. In Part I of this two-phase study, screening of a representative sample of the general population (every fifth person or every fifth door using a fixed-step procedure on a random route sample) was expedited with use of a questionnaire and algorithm based on current diagnostic criteria for rosacea. Of the subjects that screened positive in the initial phase, a randomly selected sample (every third subject) t`hen underwent diagnostic confirmation by a dermatologist in Part II.A total of 3052 and 3013 subjects (aged 18-65 years) were screened in Germany and Russia respectively. Rosacea prevalence was 12.3% [95%CI, 10.2-14.4] in Germany and 5.0% [95%CI, 2.8-7.2] in Russia. The profile of subjects with rosacea (75% women; mean age of 40 years; mainly skin phototype II or III, majority of subjects with sensitive facial skin) and subtype distribution were similar. Overall, 18% of subjects diagnosed with rosacea were aged 18-30 years. Over 80% were not previously diagnosed. Within the previous year, 47.5% of subjects had received no rosacea care and 23.7% had received topical and/or systemic drugs. Over one-third (35% Germany, 43% Russia) of rosacea subjects reported a moderate to severe adverse impact on quality of life.Rosacea is highly prevalent in Germany (12.3%) and Russia (5.0%). The demographic profile of rosacea subjects was similar between countries and the majority were previously undiagnosed.
Ovid Technologies (Wolters Kluwer Health)
Treatment of Ocular Rosacea With Once-Daily Low-Dose Doxycycline
Sobolewska B., Doycheva D., Deuter C., Pfeffer I., Schaller M., Zierhut M.
Cornea scimago Q1 wos Q2 , 
2014-01-22,  citations by CoLab: 51 ,  Abstract  
The aim of this study was to determine the efficacy of once-daily systemic treatment of ocular rosacea with a slow-release form of 40 mg of doxycycline.Fifteen patients with ocular rosacea were enrolled between February 2010 and October 2012 in a retrospective observational case series. Patient complaints and clinical findings including blepharitis with telangiectasia and meibomian gland dysfunction, conjunctival redness, and fluorescein staining of the cornea were evaluated. The ocular manifestations were scored as follows: 0-absent, 1-mild, 2-moderate, and 3-severe. All measurements were repeated at the 6-week follow-up visit. The mean duration of treatment was 8 months (range, 5-12 months), and the mean duration of the follow-up was 9 months (range, 6-17 months).At the baseline visit, 73.3% of the patients had severe complaints, and 80% had severe blepharitis despite topical therapy with artificial tears and eyelid hygiene. After 12 weeks of systemic therapy, severe complaints and blepharitis strongly improved and were seen in only 13.3% and 20% of the patients (P = 0.01). Follow-up investigations 6 to 17 months after discontinuation of the treatment showed further significant improvement of complaints (absent or mild in 66.7% and 20% of the patients, respectively) and blepharitis (absent or mild in 26.7% and 60% of the patients, respectively). One patient had a mild stomach ache so that therapy was shortened to 5 months.An antiinflammatory dose of slow-release doxycycline 40 mg given daily may be an effective and safe therapy of ocular rosacea.
Taylor & Francis
Prevalence of and Associated Factors for Dry Eye in a Spanish Adult Population (The Salnes Eye Study)
Viso E., Rodriguez-Ares M.T., Gude F.
Ophthalmic Epidemiology scimago Q1 wos Q3 , 
2009-01-01,  citations by CoLab: 145 ,  Abstract  
To estimate the prevalence of dry eye and to investigate its relationship with lifestyle and systemic factors in a general adult population in north-western Spain.A dry eye questionnaire was administered and objective tests were performed in 654 individuals [mean age (Standard deviation): 63.6 (14.4) years, range: 40-96, 37.2% males]. Subjects were considered symptomatic when one or more of the symptoms of the questionnaire were present often or all the time. Schirmer test or= 1 were considered indicative of signs. Dry eye was defined as the simultaneous presence of symptoms and at least one sign. A design based analysis was performed and all calculations were weighted to give unbiased estimates.Dry eye prevalence was 11.0% (95%confidence interval [CI] 8.6-13.3). Dry eye was found to be more frequent in women (11.9%, 95%CI 8.8-15.1) than in men (9.0%, 95%CI 5.3-12.6), and was significantly associated with aging (p < 0.001). After controlling for age and sex, acne rosacea was the only factor associated with the disease. There were no habits or systemic factors associated with symptoms. However, autoimmune diseases, acne rosacea, and computer use were found to be independently and significantly associated with signs.Dry eye is a common disease in this adult European population and is more frequent in older subjects. Acne rosacea is the only factor associated with dry eye. Other factors are associated with signs but not with symptoms.
Wiley
Modified-Release Subantimicrobial Dose Doxycycline Enhances Scaling and Root Planing in Subjects With Periodontal Disease
Preshaw P.M., Novak M.J., Mellonig J., Magnusson I., Polson A., Giannobile W.V., Rowland R.W., Thomas J., Walker C., Dawson D.R., Sharkey D., Bradshaw M.H.
Journal of Periodontology scimago Q1 wos Q1 , 
2008-03-03,  citations by CoLab: 59 ,  Abstract  
Previous studies showed that adjunctive subantimicrobial dose doxycycline (SDD; 20 mg, twice daily) provides significant clinical benefits to scaling and root planing (SRP). A modified-release SDD formulation containing 40 mg doxycycline (SDD-40) to be taken once daily has been developed. The aim of this study was to investigate the efficacy of SDD-40 when used as an adjunct to SRP for the treatment of periodontitis.A 9-month, double-masked, randomized, placebo-controlled, multicenter study was conducted to test the efficacy of adjunctive SDD-40 in 266 subjects with periodontitis. Subjects were treated by SRP and randomized to receive SDD-40 or placebo for 9 months with evaluations at 3, 6, and 9 months.Adjunctive SDD-40 provided significantly greater clinical benefits than placebo at all time points. At month 9, at sites with baseline probing depths (PD) > or =6 mm, 72% to 76% of sites in the SDD-40 group demonstrated clinically significant PD reductions and clinical attachment level (CAL) gains > or =2 mm compared to 56% to 58% of sites in the placebo group (P or =3 mm compared to 32% of sites in the placebo group (P
Ovid Technologies (Wolters Kluwer Health)
Oral Tetracyclines for Ocular Rosacea: An Evidence-Based Review of the Literature
Stone D.U., Chodosh J.
Cornea scimago Q1 wos Q2 , 
2003-12-18,  citations by CoLab: 51 ,  Abstract  
To review the basis for the use of oral tetracyclines in ocular rosacea.Review of the published literature.Two prospective, masked, and placebo-controlled studies of oxytetracycline for ocular rosacea demonstrated a modest treatment benefit. Studies performed with tetracycline and doxycycline for ocular rosacea were not placebo controlled, and the optimal drug, dose, and schedule of administration were not evaluated.Available evidence supports a moderate treatment benefit in ocular rosacea for oxytetracycline, a tetracycline derivative not currently available in the United States. The efficacies of doxycycline and tetracycline, including treatment effect, optimal dose, duration of therapy, and side effects when used for ocular rosacea have not been established.
American Medical Association (AMA)
Effects of Subantimicrobial-Dose Doxycycline in the Treatment of Moderate Acne
Skidmore R., Kovach R., Walker C., Thomas J., Bradshaw M., Leyden J., Powala C., Ashley R.
Archives of Dermatology , 
2003-04-01,  citations by CoLab: 166 ,  Abstract  
To determine if treatment with subantimicrobial-dose (SD) doxycycline hyclate (20-mg tablets taken twice daily) improved clinical outcome, had any detectable effect on skin flora, led to overgrowth or colonization of skin by opportunistic pathogens, or resulted in an increase in antibiotic resistance by the surface skin microflora in patients with moderate acne compared with placebo.Multicenter, double-blind, randomized, placebo-controlled, parallel-group trial.Two university-based clinics.Adults (N = 51) with moderate facial acne.Patients were randomized to receive SD doxycycline (Periostat; CollaGenex Pharmaceuticals Inc, Newtown, Pa) or placebo twice daily for 6 months. MAIN EFFICACY OUTCOMES: Primary: changes from baseline in numbers of inflammatory, noninflammatory, and total lesions. Secondary: changes from baseline of individual counts of papules, pustules, and nodules and global assessments of clinical improvement by patient and physician.Forty patients completed 6 months of treatment. At 6 months, the SD doxycycline group had a significantly greater percent reduction in the number of comedones (P
Elsevier
Ocular Rosacea
Karamursel Akpek E., Merchant A., Pinar V., Foster C.S.
Ophthalmology scimago Q1 wos Q1 , 
1997-11-01,  citations by CoLab: 161 ,  Abstract  
Abstract Purpose: The purpose of this report is to review the presenting symptoms and signs, treatment regimens used, complications encountered, and outcome in a cohort of patients with ocular rosacea. Methods: The medical records of 131 patients with a diagnosis of ocular rosacea were reviewed retrospectively. Data were entered in a tabulated form, and a descriptive analysis was performed. Results: The age range at presentation was between 23 and 85 years (mean, 56 years). Cutaneous manifestations of rosacea were present in 112 of the patients at their first visit. The most common presenting symptoms were foreign body sensation and burning, and the most common signs were telangiectasia and irregularity of lid margins, and meibomian gland dysfunction. Thirteen patients had decreased visual acuity at the time of presentation due to corneal complications. Six of these patients required penetrating keratoplasty during the course of their disease. Seven patients had severe cicatrizing conjunctivitis at the time of referral. One hundred thirteen patients were treated with oral tetracycline derivatives. Seven patients were left with visual acuity less than 20/400, and one patient underwent enucleation for corneal perforation and endophthalmitis. Conclusions: Ocular rosacea is a common disease involving the skin and the eyes. It is widely underdiagnosed by many ophthalmologists despite the blinding potential. Successful therapy requires a multidisciplinary approach.
Elsevier
Efficacy of Doxycycline and Tetracycline in Ocular Rosacea
Frucht-Pery J., Sagi E., Hemo I., Ever-Hadani P.
American Journal of Ophthalmology scimago Q1 wos Q1 , 
1993-07-01,  citations by CoLab: 94 ,  Abstract  
We compared the effects of doxycycline and tetracycline hydrochloride on the subjective symptoms in ocular rosacea. Twenty-four patients with symptomatic ocular rosacea were randomly assigned to two groups and treated with doxycycline 100 mg/day (group 1, 16 patients) or tetracycline hydrochloride 1 g/day (group 2, eight patients). The dosages of each drug were gradually tapered and discontinued according to symptomatic response. At each examination all the manifesting symptoms were scored by the patients. Patients were followed up from six weeks to three years. After six weeks of drug treatment, all patients except one had symptomatic improvement. Although most of the scores of the symptoms were significantly decreased in both groups, greater symptomatic relief occurred in the tetracycline hydrochloride-treated patients (P = .041). However, after three months of treatment there was no significant difference in symptoms between the two groups. Gastrointestinal tract complications occurred in two of the 16 patients (12.5%) in group 1 and in three of the eight patients (37.5%) in group 2. Both tetracycline hydrochloride and doxycycline can control the symptoms of ocular rosacea.
Elsevier
Ocular rosacea
Browning D.J., Proia A.D.
Survey of Ophthalmology scimago Q1 wos Q1 , 
1986-11-01,  citations by CoLab: 124 ,  Abstract  
The demographic, clinical, and histopathologic characteristics of ocular rosacea are reviewed, with emphasis on examination of the skin in patients with external ocular disease. Since no single clinical or pathological hallmark of rosacea exists, a proposed point system for diagnosis is presented. Studies of pathogenesis reveal that no single unifying hypothesis accounts for all the expressions of ocular rosacea. Reports of treatment with tetracycline and other antibiotics demonstrate efficacy, although the mechanisms of action of these drugs are not known. More recently, other classes of drugs, including isotretinoin and hexachlorocyclohexane, have proven to be effective in dermatologic manifestations of rosacea, but effects on ocular manifestations are unknown.
Oxford University Press
NOTE ON AN EXACT TREATMENT OF CONTINGENCY, GOODNESS OF FIT AND OTHER PROBLEMS OF SIGNIFICANCE
FREEMAN G.H., HALTON J.H.
Biometrika scimago Q1 wos Q1 , 
1951-01-01,  citations by CoLab: 633 , 
Found 2
By date By citations
Ovid Technologies (Wolters Kluwer Health)
Ocular Rosacea: An Updated Review
Mohamed-Noriega K., Loya-Garcia D., Vera-Duarte G.R., Morales-Wong F., Ortiz-Morales G., Navas A., Graue-Hernandez E.O., Ramirez-Miranda A.
Cornea scimago Q1 wos Q2 , 
2025-01-14,  citations by CoLab: 0 ,  Abstract  
Purpose: Ocular rosacea is a chronic inflammatory disorder affecting the ocular surface, often associated with cutaneous rosacea. This review aims to explore its pathogenesis, treatment approaches, and future directions for management. Methods: A review of current literature on the pathophysiology, clinical features, and treatment strategies of ocular rosacea in adults and children (pediatric blepharokeratoconjunctivitis) was conducted. Emerging research on immune dysregulation, microbiome alterations, and potential therapeutic targets was analyzed. Results: Ocular rosacea involves dysregulation of the immune and neurovascular systems, with toll-like receptor activation and complement system involvement leading to chronic ocular surface inflammation. Alterations in the ocular microbiome have been implicated in disease progression. Treatment strategies emphasize a stepwise approach, incorporating ocular and skin hygiene, lifestyle modifications, and pharmacological interventions. Recent advancements in understanding the disease mechanisms have led to the exploration of targeted therapies, including biologics and small-molecule inhibitors. Conclusions: Ocular rosacea remains challenging to diagnose and treat, particularly in children (pediatric blepharokeratoconjunctivitis), often leading to delayed intervention and poor outcomes. A multidisciplinary approach, including new therapeutic options, holds promise for improving patient care. Further research into the genetic and molecular basis of ocular rosacea may enable more personalized treatments.
Elsevier
Investigation of Choroidal Thickness and Choroidal Vascularity Index in Ocular Rosacea Patients According to Skin Subtypes
Yesilirmak N., Kurt B., Aktas A., Behar-Cohen F., Bourges J.
Photodiagnosis and Photodynamic Therapy scimago Q2 wos Q2 Open Access , 
2024-10-01,  citations by CoLab: 1 ,  Abstract  
To compare the choroidal thickness (CT) and choroidal vascularity index (CVI) values in ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls.

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