Ocular rosacea: An update on pathogenesis and therapy

Current Opinion in Ophthalmology

Volumn 15, Issue 6, 2004, Pages 499-502

  Stone, Donald U ^a   Chodosh, James ^a,b  

^a UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE   (United States)

^b UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER   (United States)

Author keywords

Ocular surface; Rosacea; Tetracycline

Indexed keywords

AMPICILLIN; ANTIBIOTIC AGENT; ANTIINFLAMMATORY AGENT; AZELAIC ACID; CLARITHROMYCIN; CLINDAMYCIN; CYCLOSPORIN A; DOXYCYCLINE; ERYTHROMYCIN; GELATINASE B; INTERLEUKIN 1ALPHA; ISOTRETINOIN; METRONIDAZOLE; MINOCYCLINE; OXYTETRACYCLINE; RETINOID; STEROID; TACROLIMUS; TETRACYCLINE DERIVATIVE; TRIACYLGLYCEROL LIPASE;

BLEPHARITIS; CATARACT; CHILDHOOD DISEASE; CLINICAL FEATURE; CLINICAL TRIAL; CONJUNCTIVA DISEASE; CORNEA EPITHELIUM; EYELID DISEASE; EYELID THINNING; HUMAN; INTRAOCULAR HYPERTENSION; MEDICAL LITERATURE; OCULAR ROSACEA; PATHOGENESIS; PREVALENCE; PRIORITY JOURNAL; PUBLICATION; REVIEW; ROSACEA; SYMPTOM;

ADMINISTRATION, ORAL; ADMINISTRATION, TOPICAL; HUMANS; PREVALENCE; ROSACEA; STEROIDS; TETRACYCLINES;

EID: 9444296529     PISSN: 10408738     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.icu.0000143683.14738.76     Document Type: Review

References (36)

1. Tolman EL: Acne and acneiform dermatoses. In Dermatology, vol 2. Edited by Moschella SL, Hurley HJ. Philadelphia: WB Saunders; 1992:1477-1492.
2. Browning DJ, Proia AD: Ocular rosacea. Surv Ophthalmol 1986, 31:145-158.
3. Akpek EK, Merchant A, Pinar V, Foster CS: Ocular rosacea patients characteristics and follow-up. Ophthalmology 1997, 104:1863-1867.
4. Stoesser F, Levy D, Moalic S, Colin J: Pseudokeratoconus and ocular rosacea. J Fr Ophtalmol 2004, 27:278-284.
5. National Rosacea Society: 14 million Americans have rosacea and most of them don't know it. Available at: http://www.rosacea.org. Accessed 6/02/2004.
6. Ghanem VC, Mehra N, Wong S, Mannis MJ: The prevalence of ocular signs in acne rosacea. Cornea 2003, 22:230-233.
7. Michel JL, Cabibel F: Frequency, severity and treatment of ocular rosacea during cutaneous rosacea. Ann Dermatol Venereol 2003, 130:20-24.
8. Starr PAJ, McDonald A: Oculo-cutaneous aspects of rosacea. Proc R Soc Med 1969, 62:9-11.
9. Millikan LE: Rosacea as an inflammatory disorder: a unifying theory? Cutis 2004, 73(suppl 1):5-8. This review and editorial article succinctly summarizes the current theory of acne rosacea as an inflammatory disorder.
10. Hoang-Xuan T, Rodriquez A, Zaltas MM, et al.: Ocular rosacea. A histologic and immunopathologic study. Ophthalmology 1990, 97:1468-1475.
11. Diaz C, O'Callaghan CJ, Khan A, Ilchyshyn A: Rosacea: A cutaneous marker of Helicobacter pylori infection? Acta Derm Venereol 2003, 83:282-286. The authors provide a brief review of the published articles addressing the role of Helicobacter pylori infection in rosacea; new data is also presented that shows no association between infection or seropositivity and rosacea, but is claimed to suggest a possible link to disease severity.
12. Argenziano G, Donnarumma G, Iovene MR, et al.: Incidence of anti-Helicobacter pylori and anti-CagA antibodies in rosacea patients. Int J Dermatol 2003, 42:601-604.
13. Pierard-Franchimont C, Quatresooz P, Pierard GE: Incidental control of rosacea by somatostatin. Dermatology 2003, 206:249-251.
14. Dahl MV, Ross AJ, Schlievert PM: Temperature regulates bacterial protein production: Possible role in rosacea. J Am Acad Dermatol 2004, 50:266-272. This study of four patients with untreated rosacea reveals an increased production of staphylococcal lipase at higher temperatures, and proposes that increased skin temperature secondary to erythema and telangiectasia leads to the inflammatory findings of acne rosacea via the induction of bacterial lipase activity.
15. Barton K, Dagoberte CM, Nava A, Pflugfelder SC: Inflammatory cytokines in the tears of patients with ocular rosacea. Ophthalmology 1997, 104:1868-1874.
16. Sobrin L, Liu Z, Monroy DC, et al.: Regulation of MMP-9 activity in human tear fluid and corneal epithelial culture supernatant. Invest Ophthalmol Vis Sci 2000, 41:1703-1709.
17. Afonso AA, Sobrin L, Monroy DC, et al.: Tear fluid gelatinase B activity correlates with IL-1 alpha concentration and fluorescein clearance in ocular rosacea. Invest Ophthalmol Vis Sci 1999, 40:2506-2512.
18. Dougherty JM, McCulley JP: Bacterial lipases and chronic blepharitis. Invest Ophthalmol Vis Sci 1986, 27:486-491.
19. Dougherty JM, McCulley JP, Slivany RE, Meyer DR: The role of tetracyclines in chronic blepharitis; inhibition of lipase production in staphylococci. Invest Ophthalmol Vis Sci 1991, 32:2970-2975.
20. Shine WE, McCulley JP, Pandya AG: Minocycline effect on meibomian gland lipids in meibomianitis patients. Exp Eye Res 2003, 76:417-420. This paper expands on prior work done by this group on meibomian gland lipids, and provides a discussion on the possible mechanism of inflammation in meibomianitis. Minocycline resulted in a decrease in the concentrations of diglycerides and free fatty acids in patients with meibomianitis.
21. Ta CN, Shine WE, McCulley JP, et al.: Effects of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis. Cornea 2003, 22:545-548. This article summarizes the evidence in support of the role of bacterial lipases and inflammatory lipids in blepharitis, and prospectively evaluates the effect of minocycline on ocular flora. There was a decrease in the number of colony-forming units cultured from the eyelids but not the conjunctiva of study patients.
22. Sadowski T, Steinmeyer J: Effects of tetracyclines on the production of matrix metalloproteinases and plasminogen activators as well as of their natural inhibitors, tissue inhibitor of metalloproteinases-1 and plasminogen activator inhibitor-1. Inflamm Res 2001, 50:175-182.
23. Nazir SA, Murphy S, Siatkowski RM, et al.: Ocular rosacea in childhood. Am J Ophthalmol 2004, 137:138-144. A retrospective case series of six pediatric patients with ocular surface signs and symptoms consistent with ocular rosacea is presented; all six patients improved on a regimen of topical corticosteroid and an oral antibiotic.
24. Gupta AK, Chaudhry MM: Critical review of the manner in which the efficacy of therapies for rosacea are evaluated. Int J Dermatol 2003, 42:909-916.
25. Gupta AK, Chaudhry MM: Evaluating the quality of rosacea studies: implications for the patient and physician. Dermatology 2003, 207:173-177.
26. Stone DU, Chodosh J: Oral tetracyclines for ocular rosacea: an evidence-based review of the literature. Cornea 2004, 23:106-109. This manuscript reviews the literature regarding oral tetracyclines as a treatment for ocular rosacea. Two small studies were found that demonstrated a modest benefit from oral oxytetracycline, with a significant placebo effect. There were no randomized, controlled, masked trials for tetracycline or doxycycline found.
27. Bartholomew RS, Reid BJ, Cheesbrough MJ, et al.: Oxytetracycline in the treatment of ocular rosacea: a double blind trial. Br J Ophthalmol 1982, 66: 386-388.
28. Seal DV, Wright P, Ficker L, et al.: Placebo controlled trial of fusidic acid gel and oxytetracycline for recurrent blepharitis and rosacea. Br J Ophthalmol 1995, 79:42-45.
29. Van Zuuren EJ, Graber MA, Hollis S: Interventions for rosacea. Cochrane Database Syst Rev 2004, 1:CD003262. This systematic review of the literature assesses and summarizes the evidence regarding efficacy and safety of treatments used for rosacea; few articles reviewed met their criteria for randomization, masking, and use of a placebo control. The authors conclude that there is good evidence to support the use of topical metronidazole, topical azelaic acid cream, and oral tetracyclines for acne rosacea.
30. Dursun D, Kim MC, Solomon A, Pflugfelder SC: Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix metalloproteinase-9, doxycycline and corticosteroids. Am J Ophthalmol 2001, 132:8-13.
31. Baratz KH, Hattenhauer MG: Indiscriminate use of corticosteroid- containing eye drops. Mayo Clin Proc 2000, 75:539.
32. Ruzicka T, Assmann T, Lebwohl M: Potential future dermatological indications for tacrolimus ointment. Eur J Dermatol 2003, 13:331-342.
33. Bamford JTM, Elliott BA, Haller IV: Tacrolimus effect on rosacea. J Am Acad Dermatol 2004, 50:107-108.
34. Pflugfelder SC: Anti-inflammatory therapy for dry eye. Am J Ophthalmol 2004, 137:337-342. This paper reviews the application of anti-inflammatory therapy for ocular surface disorders, including topical corticosteroids and cyclosporine.
35. Key JE: A comparative study of eyelid cleaning regimens in chronic blepharitis. CLAO J 1996, 22:209-212.
36. Greiner JV, Leahy CD, Glonek T, et al.: Effects of eyelid scrubbing on the lid margin. CLAO J 1999, 25:109-113.