Oxytetracycline in the treatment of ocular rosacea: a double-blind trial.

Abstract

Rosacea is a common condition affecting the skin of the face, with less frequent involvement of the eyes. Nonspecific ocular complications are similar to those found in patients with seborrhoea, blepharitis, recurrent chalazia, styes and trichiasis, hyperaemic conjunctivitis, with occasional marginal corneal infiltrates or ulcers. Specific complications include nodular conjunctivitis and episcleritis, which are rare, and the typical progressive keratitis which occurs in 5% of patients with rosacea.I Oxytetracycline given orally in low dosage for more than 6 weeks is a well recognised treatment for rosacea of the skin2' and is also reassuringly safe.7 Tetracycline has been used topically in ocular rosacea,8 and there is increasing evidence that rosacea keratitis may also respond to systemic tetracyclines.I "" I The purpose of this study was to assess the validity of these observations by means of a double-blind limited cross-over trial. Material and methodsPatients attending dermatology clinics with confirmed rosacea were questioned for possible eye symptoms. Sixty-five were subsequently screened by an ophthalmologist and were admitted to the trial if Correspondence to Dr

Rosacea

“…In a double-blind, placebo-controlled trial, 35 patients with ocular rosacea who received 250 mg of oxytetracycline twice daily for six weeks had a significantly higher rate of remission than did patients who received a placebo (65 percent vs. 28 percent). 49 In an uncontrolled study of 39 patients with cutaneous rosacea (28 with ocular symptoms), 100 mg of doxycycline daily for 12 weeks improved symptoms of dryness, itching, blurred vision, and photosensitivity. 50 After ocular symptoms subside, the maintenance of lid hygene and the use of artificial tears are usually recommended.…”

Systematic review of rosacea treatments

“…The treatments could be categorized into 5 groups: topical metronidazole (15 trials), [21][22][23]27,29,30,32,33,36,38,39,42,43,48,50 oral antibiotics (8 trials), 23,26,28,40,44,45,47,50 topical azelaic acid (6 trials), 22,31,35,36,49 topical benzoyl peroxide combined with topical antibiotics (2 trials), 34,43 and other therapies (4 trials). 37,41,44,46 Five trials included comparisons in more than one category.…”

“…27,43 Intention-to-treat analysis was used in 17 of the 29 trials. [21][22][23]26,[28][29][30][31][32][34][35][36][37][38][39]49 For 14 studies the variability (SD or SE) of continuous measurements were completely or partially lacking, making these data unusable in a metaanalysis. 21,30,[32][33][34][36][37][38][41][42][43]46,48,50 Analysis…”

“…13,86,87 Of the 29 included studies, 8 were classified as high quality. 23,26,[28][29][30]32,34,36 The remaining 21 trials were of intermediate quality. 21,22,27,31,33,35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50] In only 14 of the 29 trials 23,26,[28][29][30]32,[34][35][36]40,42,47,49 was there adequate blinding of treatment allocation.…”

“…Study duration ranged from 4 to 6 weeks. Bartholomew et al 28 addressed treatment efficacy in ocular rosacea.…”