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Treatment for Phenotype 6

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Phenotype 6 - Ocular manifestations

Ocular rosacea is common but often not recognized by the clinician.[1] It may precede, follow, or occur simultaneously with the skin changes typical of rosacea. In the absence of accompanying skin changes, ocular rosacea can be difficult to diagnose, and there is no test that will confirm the diagnosis. Patients usually have mild, nonspecific symptoms, such as burning or stinging of the eyes. A sensation of dryness is common, and tear secretion is frequently decreased. [2] Mild-to-moderate ocular rosacea (including blepharoconjunctivitis, chalazia, and hordeola) occurs frequently, whereas serious disease with the potential for visual loss, such as that which results from keratitis, occurs rarely.

Ocular problems occur in at least 50 percent of patients with rosacea. [3]

"Although considered a skin disease, rosacea may evolve the eyes in 58-72% of the patients, causing eyelid and ocular surface inflammation. About one third of the patients develop potentially sight-threatening corneal involvement. Untreated rosacea may cause varying degrees of ocular morbidity." [14]

One report said, "Patients with rosacea have thinner corneas, which could be attributed to the observed deteriorated tear function parameters." [12]

For images of Ocular Rosacea click here:


Links to get you started [5]

Dry Eye: Awareness, Diagnosis, and Management

All of the ocular rosacea articles at rosacea news

Ocular Rosacea: Dr. Eric Jones, MD

Ocular Rosacea: Dr. Mark J. Mannis, MD

Ocular Rosacea: Curse of the Celts and Celebs, Heather Potter, MD, University of Wisconsin, School of Medicine and Public Health


Astaxanthin along with some lutein and zeaxanthin
"Dr Lange also likes to add 6 mg of astaxanthin along with some lutein and zeaxanthin in moderate to marked cases of blepharitis for the additional anti inflammatory properties when used together with omega 3." Natural Treatment for Blepharitis by Dr Michael Lange

Avermectin Milbemycin Eyewash for Ocular Rosacea [7]

Cliradex [15]

Cyclosporine ophthalmic emulsion [22]

Demodex mite treatment. [8]

Intense pulsed light and low-level light therapy (IPL/LLLT) [20]


" IPL therapy also reduces signs and symptoms of DED (Dry Eye Disease)." [17]

Ivermectin [18]

Optimel [16]

"There is an emerging understanding of the efficacy of probiotics, prebiotics, synbiotics and other functional foods on gut and local ocular microbiota in modulation of ocular inflammation and ocular surface health and homeostasis....Considering mechanisms of action derived from a microbiome-driven systemic or “holistic” approach to this disease might pave the way for a new generation of rigorous clinical studies to provide alternative and more effective solutions for management of DED." [19]

Platelet-rich plasma (PRP)
One report states, "We suggest that a clinically acceptable dosage of  provides the ocular surface with the components necessary to restore normal cellular tensegrity and provides a foundation to eliminate the recurrence of the inflammation associated with DES [Dry eye syndrome]." [13]

Treating ocular rosacea (from the AAO)

Topical Cyclosporine Proves Beneficial For Ocular Rosacea [6]

Terpinen-4-ol (T4O) Pass [11] [21]

"A single or double application of ivermectin 1% cream is well tolerated and highly effective in reducing or eliminating the characteristic sleeves associated with Demodex blepharitis. The use of ivermectin 1% cream merits further investigation." [23]

Diagnostic Test 

There may be a clinical diagnositic test now available for ocular rosacea. [4]

One paper suggests, "The abundance of highly fucosylated N-glycans in the control samples and sulfated O-glycans in ocular rosacea patient samples may lead to the discovery of an objective diagnostic marker for the disease." [9] Another paper suggests, "The high abundance of oligosaccharides in the tear fluid of patients with rosacea may lead to an objective diagnostic marker for the disease." [10]

"There is not yet a diagnostic test for rosacea. The diagnosis of ocular rosacea relies on observation of clinical features, which can be challenging in up to 90% of patients in whom accompanying roseatic skin changes may be subtle or inexistent." [14]

End notes

[1] Arch Dermatol 1997;133:89-90.[CrossRef][iSI] [Medline] 
Ocular rosacea: current concepts and therapy.
Kligman AM

[2] J Am Acad Dermatol 1992;26:211-214.[iSI] [Medline]
 Schirmer testing for dry eyes in patients with rosacea.
Gudmundsen KJ, O'Donnell BF, Powell FC. 

[3] Rosacea: A Common, Yet Commonly Overlooked, Condition
Am Fam Physician. 2002 Aug 1;66(3):435-441.

[4] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea
Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan, Hao Liu,‡ Carlito B. Lebrilla, Lenio S. Alvarenga, and Mark J. Mannis
J. Proteome Res., 2005, 4 (6), pp 1981–1987, October 6, 2005, American Chemical Society

Trail of Tears May Lead to the First Diagnostic Test for Ocular Rosacea
Ocular Rosacea Test
Updated: 6/21/2006 9:16:46 AM Dental Care & Health Care Articles

[5] Link list courtesy of David Pascoe

[6] Topical Cyclosporine Proves Beneficial For Ocular Rosacea
Skin and Allergy News, Medical Dermatology
BRUCE JANCIN, Skin & Allergy News Digital Network

[7] Patent applied for by Galderma
David Pascoe's comment on the above patent

[8] In vitro and in vivo killing of ocular Demodex by tea tree oil.
Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC.
Ocular Surface Center, 7000 SW 97 Avenue, Suite 213, Miami, FL 33173, USA.
Br J Ophthalmol. 2005 Nov;89(11):1468-73.

[9] Glycomic analysis of tear and saliva in ocular rosacea patients: the search for a biomarker.
Vieira AC, An HJ, Ozcan S, Kim JH, Lebrilla CB, Mannis MJ.
Ocul Surf. 2012 Jul;10(3):184-92. Epub 2012 May 3.

[10] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea
Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan,Hao Liu, Carlito B. Lebrilla, Lenio S. Alvarenga,and Mark J. Mannis
J. Proteome Res., 2005, 4 (6), pp 1981–1987, DOI: 10.1021/pr0501620, Publication Date (Web): October 6, 2005

[11] In clinical trials as of August 2012:
Demodex Blepharitis Treatment Study (DBTS)

[12] Can J Ophthalmol. 2012 Dec;47(6):504-8. doi: 10.1016/j.jcjo.2012.07.009.
Central corneal thickness in patients with mild to moderate rosacea.
Onaran Z, Karabulut AA, Usta G, Ornek K.

[13] Optometry. 2012 Mar 30;83(3):111-3.
Dry-eye--is inflammation just the tip of the iceberg?
Jarka ES, Kahrhoff M, Crane JB.

[14] Arq Bras Oftalmol. 2012 Oct;75(5):363-9.
Ocular rosacea: a review.
Vieira AC, Höfling-Lima AL, Mannis MJ.

[16] judworth [post no 6] says, "For those of you plagued by ocular rosacea (I have MGD) and very red and sore outer lash line, I have been using Optimel for just over 2 weeks, together with a cream cleanser Ilast and the results are very encouraging! I would say the above products have improved my issues by about 70% already (Optimel says improvement by 4 weeks)."
[17] Clin Ophthalmol. 2017 Jun 20;11:1167-1173. doi: 10.2147/OPTH.S139894. eCollection 2017.
Intense pulsed light for evaporative dry eye disease.
Dell SJ.
[18] Br J Dermatol. 2018 Mar 12. doi: 10.1111/bjd.16534. 
Successful therapy of ocular rosacea with topical ivermectin.
Schaller M, Pietschke K.

"To investigate the efficacy of once-daily topical treatment of ocular and cutaneous rosacea with ivermectin 1% cream (Soolantra®, Galderma)....Topical ivermectin cream 1% given daily is an effective and safe therapy against rosacea."
Ocul Immunol Inflamm. 2020 Apr 07;:1-5
Efficacy of Topical Ivermectin for the Treatment of Cutaneous and Ocular Rosacea.
Sobolewska B, Doycheva D, Deuter CM, Schaller M, Zierhut M
[19] Antibiotics (Basel). 2019 Sep; 8(3): 88.
The Case for a More Holistic Approach to Dry Eye Disease: Is It Time to Move beyond Antibiotics?
Azadeh Tavakoli and Judith Louise Flanagan
[20] Clin Ophthalmol. 2021; 15: 2133–2140.
Combined Intense Pulsed Light and Low-Level Light Therapy for the Treatment of Dry Eye: A Retrospective Before–After Study with One-Year Follow-Up
Miguel Angel Pérez-Silguero, David Pérez-Silguero, Amado Rivero-Santana, Maria Inmaculada Bernal-Blasco, Pablo Encinas-Pisa
[21] Successful management of chronic Blepharo-rosacea associated demodex by lid scrub with terpinen-4-ol
Han Y. Yin, Sean Tighe, Scheffer CG. Tseng, Anny MS. Cheng
Am J Ophthalmol Case Rep. 2021 Sep; 23: 101171. Published online 2021 Jul 22. doi: 10.1016/j.ajoc.2021.101171
[22] Skin Therapy Lett. 2021 Jul;26(4):1-8.
Rosacea: An Update in Diagnosis, Classification and Management
Cindy Na-Young Kang, Monica Shah, Jerry Tan
[23] Am J Ophthalmol Case Rep. 2022 Jun; 26: 101551.
Treatment of ocular Demodex infestation with topical ivermectin cream
Craig J. Helm
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