eMedicine Specialties > Ophthalmology > Dermatologic Disorders

Ocular Rosacea: Follow-up

Author: J Bradley Randleman, MD, Associate Professor, Department of Ophthalmology, Section of Cornea, External Disease and Refractive Surgery, Emory University School of Medicine; Director of Cornea, External Disease and Refractive Surgery Fellowship, Emory University; Physician Member, Section of Ophthalmology, The Emory Clinic
Coauthor(s): Evan S Loft, MD, Staff Physician, Department of Ophthalmology, Emory University; C Diane Song, MD, Chief of Ophthalmology, Asheville Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Feb 20, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is rarely necessary, except in some cases of corneal perforations or severe secondary corneal infections.

Further Outpatient Care

  • Rosacea is a chronic condition, and long-term management is necessary to control this disease.
  • Dermatology and ophthalmology visits may be necessary, and they could initially be frequent to gain control over the symptoms or to protect an endangered cornea.

Inpatient & Outpatient Medications

  • Lid hygiene
  • Artificial tears
  • Oral antibiotics - Doxycycline, tetracycline, clarithromycin, or metronidazole
  • Erythromycin ointment
  • Topical metronidazole
  • Topical steroids

Deterrence/Prevention

  • Patients should avoid trigger foods and situations.
  • For some patients, avoidance of sunlight can minimize flare-ups.

Complications

  • Complications include corneal vascularization, ulceration, perforations, secondary bacterial infections, and, ultimately, decreased vision.
  • Eyes undergoing penetrating keratoplasty are more likely to experience graft rejection than eyes without rosacea because of the increased inflammatory response and the relatively increased corneal vasculature.

Prognosis

  • Rosacea can be controlled symptomatically but is generally a chronic condition, which requires long-term, follow-up care.

Patient Education

  • Informing patients of the chronic, relapsing nature of rosacea is important so that patient expectation matches available therapy and patient follow-up care is maximized.
  • Ophthalmologists may underdiagnose rosacea because of a lack of familiarity with the dermatologic manifestations of the disease.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize, diagnose, and treat rosacea can compromise the integrity of the ocular surface.

Special Concerns

  • Because rosacea is a chronic, often progressive disease, patients are likely to become increasingly symptomatic as they age.
  • Patients need to understand that rosacea is a chronic condition, requiring long-term treatment.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.



More on Ocular Rosacea

Overview: Ocular Rosacea
Differential Diagnoses & Workup: Ocular Rosacea
Treatment & Medication: Ocular Rosacea
Follow-up: Ocular Rosacea
Multimedia: Ocular Rosacea
References
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References

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  2. Knox CM, Smolin G. Rosacea. Int Ophthalmol Clin. Spring 1997;37(2):29-40. [Medline].

  3. Powell FC. Clinical practice. Rosacea. N Engl J Med. Feb 24 2005;352(8):793-803. [Medline].

  4. Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol. Apr 2002;46(4):584-7. [Medline].

  5. Akpek EK, Merchant A, Pinar V, Foster CS. Ocular rosacea: patient characteristics and follow-up. Ophthalmology. Nov 1997;104(11):1863-7. [Medline].

  6. Browning DJ, Proia AD. Ocular rosacea. Surv Ophthalmol. Nov-Dec 1986;31(3):145-58. [Medline].

  7. Wilkin JK. Rosacea. Pathophysiology and treatment. Arch Dermatol. Mar 1994;130(3):359-62. [Medline].

  8. Tisma VS, Basta-Juzbasic A, Jaganjac M, et al. Oxidative stress and ferritin expression in the skin of patients with rosacea. J Am Acad Dermatol. Feb 2009;60(2):270-6. [Medline].

  9. Chamaillard M, Mortemousque B, Boralevi F, et al. Cutaneous and ocular signs of childhood rosacea. Arch Dermatol. Feb 2008;144(2):167-71. [Medline].

  10. Viso E, Rodriguez-Ares MT, Gude F. Prevalence of and associated factors for dry eye in a Spanish adult population (the Salnes Eye Study). Ophthalmic Epidemiol. Jan-Feb 2009;16(1):15-21. [Medline].

  11. Icasiano E, Latkany R, Speaker M. Chronic epiphora secondary to ocular rosacea. Ophthal Plast Reconstr Surg. May-Jun 2008;24(3):249. [Medline].

  12. Frucht-Pery J, Sagi E, Hemo I, Ever-Hadani P. Efficacy of doxycycline and tetracycline in ocular rosacea. Am J Ophthalmol. Jul 15 1993;116(1):88-92. [Medline].

  13. Modi S, Harting M, Rosen T. Azithromycin as an alternative rosacea therapy when tetracyclines prove problematic. J Drugs Dermatol. Sep 2008;7(9):898-9. [Medline].

  14. Torresani C. Clarithromycin: a new perspective in rosacea treatment. Int J Dermatol. May 1998;37(5):347-9. [Medline].

  15. Barnhorst DA Jr, Foster JA, Chern KC, Meisler DM. The efficacy of topical metronidazole in the treatment of ocular rosacea. Ophthalmology. Nov 1996;103(11):1880-3. [Medline].

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Further Reading

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Keywords

ocular rosacea, rosacea, adult acne, inflammatory keratitis, corneal ulceration, corneal perforation

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Contributor Information and Disclosures

Author

J Bradley Randleman, MD, Associate Professor, Department of Ophthalmology, Section of Cornea, External Disease and Refractive Surgery, Emory University School of Medicine; Director of Cornea, External Disease and Refractive Surgery Fellowship, Emory University; Physician Member, Section of Ophthalmology, The Emory Clinic
J Bradley Randleman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Cornea Society, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Evan S Loft, MD, Staff Physician, Department of Ophthalmology, Emory University
Evan S Loft, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

C Diane Song, MD, Chief of Ophthalmology, Asheville Veterans Affairs Medical Center
C Diane Song, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

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