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Symptoms

• Eyelid: Telangiectasia at the eyelid margin and posterior blepharitis; often with recurrent hordeola
• Conjunctiva: Conjunctival granulomas, phlyctenulosis
• Cornea: Marginal keratitis, peripheral vascularisations

Local Therapy

• e.g. Fucithalmic ointment (fusidic acid) for 4 weeks, consider additional Dexafree UD (dexamethasone)

Systemic Therapy

• Oracea (doxycycline) 40mg 1x/d for 6 weeks
  • CAVE: hepatoxicity
  • Contraindication: children and pregnancy

Alternatives:

• Minocin Akne (Minocyclin) 50mg 2x/d for 6 weeks
  • CAVE: hepatotoxicity
  • Contraindication: children and pregnancy
• Zithromax (azithromycin) 250mg 2x/d for 3d then pause for 7d, repeat for 4 cycles
  • CAVE: hepatotoxicity
• Flagyl (metronidazole) 500mg 2x/d for 10d
  • CAVE: Antabus (disulfiram)

Sources

• EyeWiki Ocular Rosacea
• The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
• Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)