Treatment of Rosacea

First-Line Treatments

• The American Academy of Ophthalmology recommends topical azelaic acid, topical ivermectin, brimonidine, doxycycline, and isotretinoin as first-line treatments for rosacea, with high-quality evidence supporting their use 1, 2, 3
• Brief courses of topical corticosteroids may be used for specific ocular complications in ocular rosacea, but should be minimized and tapered quickly, as recommended by the American Academy of Ophthalmology 1, 2

Oral Antibiotics

• The American Academy of Ophthalmology prefers doxycycline as the oral antibiotic for rosacea treatment, with oral azithromycin as an alternative 1, 2, 3

Minimizing Adverse Effects

• Even brief topical corticosteroid courses for ocular rosacea should use minimal effective doses with site-specific agents like loteprednol etabonate to minimize adverse effects, as recommended by the American Academy of Ophthalmology 1, 2