Ocular rosacea: Signs, symptoms, and tear studies before and after treatment with doxycycline

Objective: To examine ocular signs, symptoms, and results of tear analysis in patients with cutaneous rosacea before, during, and after doxycycline therapy. Design: Before-after trial. Setting: General community. Patients or Other Participants: Thirty-nine patients with cutaneous rosacea underwent dermatologic and ocular examinations, resting of tear break-up time, and Schirmer testing at baseline and 4, 8, and 12 weeks. Six patients did not complete the study. Baseline tear break-up time and results of Schirmer test were compared with those of 13 patients without rosacea who were matched for age and sex. Intervention: Patients with rosacea were given doxycycline, 100 mg daily for 12 weeks. Main Outcome Measure: Statistically significant (P, .05) improvement in tear break-up time. Result: The most frequent ocular symptoms were dryness, itching, blurred vision, and photosensitivity, all of which improved significantly with treatment. All patients had signs of ocular disease, most commonly erythema and telangiectasia, meibomian gland dysfunction, and ciliary base injection. Significant improvement (P, .05) for scales, erythema and telangiectasia, ciliary base injection, bulbar injection, papillary hypertrophy, and punctate epithelial erosions was seen. Average tear break-up time for the patients with rosacea was 5.7 seconds, which improved to 10.8 seconds after 12 weeks of treatment (P=.007). Baseline tear break-up time was significantly lower than for the comparison group of normal subjects (P=.001). There was no correlation between severity of cutaneous disease and ocular disease. Conclusions: All patients with cutaneous rosacea had some degree of ocular involvement. Tear break-up time is abnormal in patients with rosacea. Ocular erythema anti telangiectasia, meibomian gland dysfunction, and short tear break-up time in patients with cutaneous rosacea are indicators of ocular rosacea. Doxycycline, 100 mg daily, will improve ocular disease and increase the tear break-up time.