Ocular Rosacea Medication

Updated: Apr 07, 2017
  • Author: Bhairavi Kharod-Dholakia, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Antibiotics

Class Summary

Anti-inflammatory effect helps to ameliorate meibomian gland disease.

Tetracycline

Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). Has anti-inflammatory activity. Also a potent collagenase inhibitor.

Doxycycline (Vibramycin, Doryx, Adoxa, Alodox)

DOC; inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). Has anti-inflammatory activity. Also a potent collagenase inhibitor.

Clarithromycin (Biaxin, Biaxin XL)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes causing RNA-dependent protein synthesis to arrest. Effective through secondary, anti-inflammatory action.

Metronidazole (Flagyl, MetroCream, Rosadan, Vandazole)

Has anti-inflammatory and immunosuppressive activity. Topical and systemic dosage forms have been found to be effective.

Erythromycin ophthalmic (Ilotycin)

Used to decrease meibomian gland bacterial overgrowth.

Azithromycin ophthalmic (AzaSite)

This ophthalmic macrolide antibiotic is indicated for bacterial conjunctivitis may be used off label in the treatment of meibomian gland dysfunction.

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Retinoid-like Agents

Class Summary

Decrease sebaceous gland size and sebum production. May inhibit sebaceous gland differentiation and abnormal keratinization.

Isotretinoin (Amnesteem, Claravis, Myorisan, Sotrel)

Reduces sebum production and sebaceous follicle size.

Tretinoin topical (Avita, Retin-A, Retin-A Micro, Ronova)

Structurally related to vitamin A. Reduces sebum production and sebaceous follicle size. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. May help restore sun-damaged skin. Long-term, low-dose therapy may be suitable for selected patients.

Inhibits microcomedo formation and eliminates lesions present. Available as 0.025%, 0.05%, and 0.1% creams. Available also as 0.01% and 0.025% gels.

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Corticosteroids

Class Summary

Topical steroids occasionally are needed to help suppress inflammatory changes in the cornea.

Prednisolone acetate (Omnipred, Pred Mild, Pred Forte)

Decreases inflammation and corneal neovascularization. Suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability.

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Immunosuppressants

Class Summary

These agents regulate key regulatory steps responsible for inflammation.

Cyclosporine ophthalmic (Restasis)

Used to relieve dry eyes caused by suppressed tear production secondary to ocular inflammation. Thought to act as partial immunomodulator. Exact mechanism of action is not known.

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Ophthalmic Lubricants

Class Summary

Lubricants act as humectants in the eye. The ideal artificial lubricant should be preservative-free; contain potassium, bicarbonate, and other electrolytes; and have a polymeric system to increase its retention time. Lubricating drops are used to reduce morbidity and to prevent complications. Lubricating ointments prevent complications from dry eyes. Ocular inserts reduce symptoms resulting from moderate to severe dry eye syndromes.

Artificial tears (Advanced Eye Relief, Bion Tears, Hypo Tears, Murine Tears, Tears Naturale II)

Artificial tears are used to increase lubrication of the eye. Nonpreserved artificial tears are recommended for use. Tears should be applied liberally throughout the day, and, if necessary, a lubricating ointment may be used at night. This ointment may contain an antibiotic preparation.

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