Ocular rosacea. Signs, symptoms, and tear studies before and after treatment with doxycycline
M. J. Quarterman, D. W. Johnson, D. C. Abele, J. L. Lesher Jr, D. S. Hull and L. S. Davis
Department of Medicine, Medical College of Georgia, Augusta, USA.
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, testing 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 and 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.
