Ocular Rosacea

Differential diagnosis

Possible management by Optometrist

Treatment

Ocular lubricants for tear deficiency/instability related symptoms (drops for use during the day, unmedicated ointment for use at bedtime)
Treat associated posterior blepharitis
PoM Antibiotics require co-management with GP- tetracyclines contra-indicated in children, pregnant women, breast-feeding women
- PoM Topical Metronidazole 0.75% gel (adults over 18 years) applied thinly twice daily to face and eyelids for 6 to 9 weeks, then intermittently
  - Review at 6 to 9 weeks
  - If effective options, depending on patient preference, are:
    - Stop treatment and review regularly
    - Tail treatment off
      - Reduce frequency to alternate days, then twice weekly
      - Long term intermittent maintenance may be required
    - If ineffective consider oral antibiotic
  - PoM Doxcycline (adults over 18 years) 100mg once daily for up to 3 months, repeated courses may be necessary
  - Or PoM Erythromycin (adults over 18 years), if tetracyclines contraindicated, 500mg twice a day for up to 3 months; repeated courses may be necessary
    - Review at 3 months
    - If effective options, depending on patient preference, are
      - Stop treatment and review regularly
      - Tail treatment off then stop
        
        Halve dose for 2-6 months
        
        Long term intermittent maintenance may be required
      - Switch to Topical Metronidazole 0.75% gel

Advice

Explain rosacea is an idiopathic long-term skin condition, which comes and goes
- It causes inflammation of the skin of the face and the eyelids, particularly cheeks, forehead and chin
- Swelling of the nose (rhinophymoma), a complication that patients often fear, is uncommon, especially in women, and treatable
- Rosacea is not caused by poor hygiene or excess alcohol intake
Facial flushing and skin irritation may be triggered by extremes of temperature, sunlight, strenuous exercise, stress, spicy foods, caffeine, cheese, alcohol, and hot drinks
Wear a broad-brimmed hat to protect the face when going out in the sun
Use a high-factor sunscreen (sun-protection factor 30 or more) to the face and eyelids 15 to 30 minutes before going out in the sun and every 2 hours thereafter
Advise the use of hypoallergenic emollients If the skin is dry
British Association of Dermatologists has useful patient information

Management Category

Possible management by Ophthalmologist