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Oral Tetracyclines for Ocular Rosacea: An Evidence-Based Review of the Literature

Stone, Donald U. MD; Chodosh, James MD


Purpose: To review the basis for the use of oral tetracyclines in ocular rosacea.

Methods: Review of the published literature.

Results: Two prospective, masked, and placebo-controlled studies of oxytetracycline for ocular rosacea demonstrated a modest treatment benefit. Studies performed with tetracycline and doxycycline for ocular rosacea were not placebo controlled, and the optimal drug, dose, and schedule of administration were not evaluated.

Conclusions: Available evidence supports a moderate treatment benefit in ocular rosacea for oxytetracycline, a tetracycline derivative not currently available in the United States. The efficacies of doxycycline and tetracycline, including treatment effect, optimal dose, duration of therapy, and side effects when used for ocular rosacea have not been established.

Acne rosacea is a common, chronic skin disorder distinguished by the presence of telangiectasia, erythema, papules, pustules, and sebaceous gland hypertrophy in the flush areas of the face, including the forehead, cheeks, and nose. 1 Ocular signs and symptoms are common and include foreign body sensation, photophobia, lid margin telangiectasia, meibomian gland inflammation and inspissation, decreased tear break-up time, conjunctival hyperemia, and marginal corneal ulcers and vascularization. 2 Since the first description of the use of tetracycline for rosacea by Sneddon 3 in 1966, tetracyclines have become a mainstay of treatment of cutaneous as well as ocular rosacea. In the context of recent efforts to differentiate common therapeutic practice based on anecdotal case reports, retrospective case series, or frank speculation from those therapies founded on prospective, placebo-controlled and masked treatment trials, 4 we sought to determine the clinical foundations for the use of oral tetracycline or its derivatives as therapy for ocular rosacea.

From the Molecular Pathogenesis of Eye Infection Research Center, Dean A. McGee Eye Institute, Departments of Ophthalmology (Drs. Stone and Chodosh) and Cell Biology (Dr. Chodosh), University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Received for publication May 8, 2003;

revision received August 6, 2003; accepted August 8, 2003.

Supported in part by a Lew R. Wasserman Merit Award to J.C. from Research to Prevent Blindness, Inc., New York, NY.

Reprints: James Chodosh, MD, DMEI-OUHSC, 608 Stanton L. Young Blvd., Oklahoma City, OK 73104 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.