Ocular Rosacea: Beyond the Skin
DOI:
https://doi.org/10.12775/QS.2026.49.67332Keywords
doxycyline, dry eye disease, eye manifestations, keratitis, meibomian gland dysfunction, ocular rosacea, rosaceaAbstract
Background: To the development of rosace contribute factors such as genetic, environmental, and neurovascular causes.. The ocular form affects an estimated prevalence of 10-46% of patients. Symptoms may include redness and tearing of the eyes, foreign body sensation, burning, dryness, itching, photophobia, blurred vision, eyelid margin telangiectasia, and periorbital erythema.
Purpose: Ocular rosacea is a long lasting condition that causes persistent inflammation of the eyes and eyelids. The aim of this paper is to organize information on the etiopathogenesis, diagnosis and treatment of this disease.
Methods: Comprehensive review of the literature available on PubMed, Google Scholar, Scopus database by searching the keywords “rosacea”, “ocular rosacea”, “ ocular rosacea treatment”, “keratitis”, “dry eye syndroms”
Results: Diagnosis requires vigilance because the disease is often confused with other ophthalmological conditions. There are no specific treatment guidelines for ocular rosacea. Managment options depend on the stage of the disease, ranging from conservative treatment based on proper eyelid hygiene and avoidance of triggers in the mildest cases to long-term systemic antibiotic therapy in patients with advanced disease.
Conclusions: Ocular rosacea is a disease that is not yet fully understood. Expanding research on this manifestation of rosacea is essential to develop standards for diagnosis and treatment. Collaboration between physicians from multiple specialties in patient care is essential to ensure rapid diagnosis and comprehensive treatment.
References
[1] Huynh, T. T. (2013). Burden of disease: The psychosocial impact of rosacea on a patient's quality of life. American Health & Drug Benefits, 6(6), 348–354.
[2] Geng, R. S. Q., Li, X., Wang, Y., & Zhang, H. (2024). Rosacea: Pathogenesis and therapeutic correlates. Dermatology Research and Practice, 28(2), 178–189.
[3] Rainer, B. M., Kang, S., & Chien, A. L. (2017). Rosacea: Epidemiology, pathogenesis, and treatment. Dermato-Endocrinology, 9(1), e1361574.
[4] Mohamed-Noriega, K., López-Muñoz, E., & Pérez-Fernández, A. (2025). Ocular rosacea: An updated review. Cornea, 44(4), 525–537.
[5] Zierl, S., Schaller, M., & Braun, R. P. (2022). Clinical clues to identify patients with ocular rosacea: A Germany-wide epidemiologic analysis. International Journal of Dermatology, 61(7), 880–885.
[6] Schaller, M., Aroni, K., Thiboutot, D., et al. (2020). Recommendations for rosacea diagnosis, classification and management: Update from the global ROSacea COnsensus 2019 panel. British Journal of Dermatology, 182(5), 1269–1276.
[7] Saá, F. L., Cremona, F., & Chiaradia, P. (2021). Association between skin findings and ocular signs in rosacea. Turkish Journal of Ophthalmology, 51(6), 338–343.
[8] Branisteanu, D. C., Popescu, R. A., & Mihailescu, D. (2020). Ocular cicatricial pemphigoid (Review). Experimental and Therapeutic Medicine, 20(4), 3379–3382.
[9] Brown, T. T., Smith, J. K., & Jones, R. L. (2014). Comparative analysis of rosacea and cutaneous lupus erythematosus: Histopathologic features, T-cell subsets, and plasmacytoid dendritic cells. Journal of the American Academy of Dermatology, 71(1), 100–107.
[10] Vieira, A. C., & Mannis, M. J. (2013). Ocular rosacea: Common and commonly missed. Journal of the American Academy of Dermatology, 69(6 Suppl 1), S36–S41.
[11] van Zuuren, E. J., Arents, B. W. M., van der Linden, M. M. D., Vermeulen, S., Fedorowicz, Z., & Tan, J. (2021). Rosacea: New concepts in classification and treatment. American Journal of Clinical Dermatology, 22(4), 457–465. https://doi.org/10.1007/s40257-021-00595-7
[12] Dhingra, D., Malhotra, C., & Jain, A. K. (2017). Ocular rosacea: A review. US Ophthalmic Review, 10(2), 113.
[13] Thiboutot, D., Anderson, R., Cook-Bolden, F., et al. (2020). Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology, 82(6), 1501–1510. https://doi.org/10.1016/j.jaad.2020.01.077
[14] Gao, Y. Y., Di Pascuale, M. A., Elizondo, A., & Tseng, S. C. (2007). Clinical treatment of ocular demodecosis by lid scrub with tea tree oil. Cornea, 26, 136–143. https://doi.org/10.1097/01.ico.0000244870.62384.79
[15] Cole, C., Shyr, T., & Ou-Yang, H. (2016). Metal oxide sunscreens protect skin by absorption, not by reflection or scattering. Photodermatology, Photoimmunology & Photomedicine, 32, 5–10.
[16] Hampton, P. J., Berth-Jones, J., Duarte Williamson, C. E., et al. (2021). British Association of Dermatologists guidelines for the management of people with rosacea 2021. British Journal of Dermatology, 185(4), 725–735. https://doi.org/10.1111/bjd.20485
[17] Tan, J., Almeida, L. M. C., Bewley, A., et al. (2017). Updating the diagnosis, classification and assessment of rosacea: Recommendations from the global ROSacea COnsensus (ROSCO) panel. British Journal of Dermatology, 176(2), 431–438. https://doi.org/10.1111/bjd.15122
[18] Bhargava, R., Kumar, P., Kumar, M., Mehra, N., & Mishra, A. (2013). A randomized controlled trial of omega-3 fatty acids in dry eye syndrome. International Journal of Ophthalmology, 6(6), 811–816. https://doi.org/10.3980/j.issn.2222-3959.2013.06.13
[19] Shen, S., Yan, G., Cao, Y., et al. (2023). Dietary supplementation of n-3 PUFAs ameliorates LL37-induced rosacea-like skin inflammation via inhibition of TLR2/MyD88/NF-κB pathway. Biomedicine & Pharmacotherapy, 157, 114091. https://doi.org/10.1016/j.biopha.2022.114091
[20] Schaller, M., Almeida, L. M., Bewley, A., et al. (2017). Rosacea treatment update: Recommendations from the global ROSacea COnsensus (ROSCO) panel. British Journal of Dermatology, 176, 465–471.
[21] Vieira, A. C., Hofling-Lima, A. L., & Mannis, M. J. (2012). Ocular rosacea: A review. Arquivos Brasileiros de Oftalmologia, 75, 363–369.
[22] Arman, A., Demirseren, D. D., & Takmaz, T. (2015). Treatment of ocular rosacea: Comparative study of topical cyclosporine and oral doxycycline. International Journal of Ophthalmology, 8(3), 544–549. https://doi.org/10.3980/j.issn.2222-3959.2015.03.19
[23] Schechter, B. A., Katz, R. S., & Friedman, L. S. (2009). Efficacy of topical cyclosporine for the treatment of ocular rosacea. Advances in Therapy, 26, 651–659. https://doi.org/10.1007/s12325-009-0037-2
[24] Malagón-Liceaga, A., Recillas-Gispert, C., Ruiz-Quintero, N. C., & Ruelas-Villavicencio, A. L. (2023). Treatment of ocular rosacea: A practical review from an interdisciplinary approach. Archivos de la Sociedad Española de Oftalmología, 98(10), 577–585. https://doi.org/10.1016/j.oftale.2023.09.001
[25] Jabbehdari, S., Memar, O. M., Caughlin, B., & Djalilian, A. R. (2020). Update on the pathogenesis and management of ocular rosacea: An interdisciplinary review. European Journal of Ophthalmology, 31(1), 22–33. https://doi.org/10.1177/1120672120937252
[26] Waszczykowska, A., Żyro, D., Jurowski, P., & Ochocki, J. (2020). Effect of treatment with silver(I) complex of metronidazole on ocular rosacea: Design and formulation of new silver drug with potent antimicrobial activity. Journal of Trace Elements in Medicine and Biology, 61, 126531.
[27] Clanner-Engelshofen, B. M., Bernhard, D., Dargatz, S., et al. (2022). S2k guideline: Rosacea. Journal der Deutschen Dermatologischen Gesellschaft, 20(8), 1147–1165. https://doi.org/10.1111/ddg.14849
[28] Oge, L. K., Muncie, H. L., & Phillips-Savoy, A. R. (2015). Rosacea: Diagnosis and treatment. American Family Physician, 92(3), 187–196.
[29] Sobolewska, B., Doycheva, D., Deuter, C. M., Schaller, M., & Zierhut, M. (2021). Efficacy of topical ivermectin for the treatment of cutaneous and ocular rosacea. Ocular Immunology and Inflammation, 29, 1137–1141.
[30] Schaller, M., Gonser, L., Belge, K., et al. (2017). Dual anti-inflammatory and anti-parasitic action of topical ivermectin 1% in papulopustular rosacea. Journal of the European Academy of Dermatology and Venereology, 31, 1907–1911.
[31] Federici, T. J. (2011). The non-antibiotic properties of tetracyclines: Clinical potential in ophthalmic disease. Pharmacological Research, 64, 614–623. https://doi.org/10.1016/j.phrs.2011.06.013
[32] Kaur, G., Redd, T. K., & Seitzman, G. D. (2023). Practice patterns and clinician opinions for treatment of ocular rosacea. Cornea, 42(11), 1349–1354. https://doi.org/10.1097/ICO.0000000000003157
[33] Preshaw, P. M., Hefti, A. F., Jepsen, S., et al. (2004). Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis: A review. Journal of Clinical Periodontology, 31, 697–707.
[34] Two, A. M., Wu, W., Gallo, R. L., et al. (2015). Rosacea: Part II. Topical and systemic therapies in the treatment of rosacea. Journal of the American Academy of Dermatology, 72, 761–770.
[35] Opitz, D. L., & Tyler, K. F. (2011). Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis. Clinical and Experimental Optometry, 94(2), 200–206.
[36] Tavassoli, S., Wong, N., & Chan, E. (2020). Ocular manifestations of rosacea: A clinical review. Clinical & Experimental Ophthalmology. https://doi.org/10.1111/ceo.13900
[37] Gonser, L. I., Gonser, C. E., Deuter, C., et al. (2017). Systemic therapy of ocular and cutaneous rosacea in children. Journal of the European Academy of Dermatology and Venereology, 31, 1732–1738.
[38] Zaslavsky, K., & Mukovozov, I. (2024). A review of intense pulsed light in the treatment of ocular rosacea. Journal of Cutaneous Medicine and Surgery, 28(4), 370–374.
[39] Bunya, V., March de Ribot, F., Barmettler, A., Yen, M. T., & Nguyen Barkat, C. (2023). Intense pulsed light (IPL) therapy. American Academy of Ophthalmology Eye Wiki. https://eyewiki.org/Intense_Pulsed_Light_(IPL)_Therapy
[40] Toyos, R., McGill, W., & Briscoe, D. (2015). Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction: A 3-year retrospective study. Photomedicine and Laser Surgery, 33, 41–46. https://doi.org/10.1089/pho.2014.3819
[41] Seo, K. Y., Kang, S. M., Ha, D. Y., Chin, H. S., & Jung, J. W. (2018). Long-term effects of intense pulsed light treatment on the ocular surface in patients with rosacea-associated meibomian gland dysfunction. Contact Lens & Anterior Eye, 41(5), 430–435. https://doi.org/10.1016/j.clae.2018.06.002
[42] Schiffman, R. M., Christianson, M. D., Jacobsen, G., Hirsch, J. D., & Reis, B. L. (2000). Reliability and validity of the Ocular Surface Disease Index. Archives of Ophthalmology, 118(5), 615–621. https://doi.org/10.1001/archopht.118.5.615
[43] Jain, A. K., & Sukhija, J. (2007). Amniotic membrane transplantation in ocular rosacea. Annals of Ophthalmology (Skokie), 39(1), 71–73.
[44] Yang, F., Wang, L., Song, D., et al. (2024). Signaling pathways and targeted therapy for rosacea. Frontiers in Immunology, 15, 1367994. https://doi.org/10.3389/fimmu.2024.1367994
[45] Browning, D. J., & Proia, A. D. (1986). Ocular rosacea. Survey of Ophthalmology, 31, 145–158.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aleksandra Bielak, Maria Spychalska, Zofia Bogiel, Aleksandra Foryś, Monika Kałwak, Daria Kuczwalska, Antonina Machała, Daria Trocka
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 24
Number of citations: 0
