Unmasking Ocular Rosacea: Diagnostic Challenges and Evolving Management

Authors

  • Anat May Tal, MD Assaf Harofeh Medical Center, Israel
  • Johanna Choremis, MD, FRCSC Jewish General Hospital, McGill University, University Ophthalmology Center, Hôpital Maisonneuve-Rosemont, Université de Montréal.
  • Julia C. Talajic, MD, MPH, FRCSC University Ophthalmology Center, Hôpital Maisonneuve-Rosemont, Université de Montréal

DOI:

https://doi.org/10.58931/cect.2025.4261

Abstract

Ocular rosacea is a chronic inflammatory condition affecting the eyes, and is often associated with cutaneous rosacea. It is a common yet frequently underdiagnosed disorder that can lead to significant ocular morbidity and, in severe cases, vision loss.

Author Biographies

Anat May Tal, MD, Assaf Harofeh Medical Center, Israel

Dr. Anat May Tal is an ophthalmologist specializing in cornea and anterior segment. After earning her medical degree from Ben Gurion University, she completed her residency at Meir Medical Center. She then pursued a fellowship in cornea and anterior segment at Shamir Medical Center, where she currently practices as a corneal specialist.

Johanna Choremis, MD, FRCSC, Jewish General Hospital, McGill University, University Ophthalmology Center, Hôpital Maisonneuve-Rosemont, Université de Montréal.

Dr. Johanna Choremis is an ophthalmologist specializing in cornea, anterior segment, and refractive surgery. After completing medical school at McGill University on a Hugh Brock Scholarship, she continued her residency at the same institution. She then completed her fellowship at Tufts University in Boston on an EA Baker Fellowship. Upon returning to Montreal, she worked at two universities: the Jewish General Hospital and the University Eye Center (CUO) at Maisonneuve-Rosemont Hospital. Over the years, she has trained several residents and cornea fellows. She has multiple publications and has presented at national and international conferences. Her main interest is in corneal transplantation and dry eye disease. She is currently the Section Head of Cornea at the University of Montreal.

Julia C. Talajic, MD, MPH, FRCSC, University Ophthalmology Center, Hôpital Maisonneuve-Rosemont, Université de Montréal

Dr. Julia Talajic is a leading ophthalmologist specializing in corneal and cataract surgery, with advanced training from the Devers Eye Institute in Portland. She was the first surgeon in Quebec to perform both Descemet Membrane Endothelial Keratoplasty (DMEK), and Corneal Allogenic Intrastromal Ring Segments (CAIRS), pioneering techniques in corneal transplantation and keratoconus treatment. She practices at Hôpital Maisonneuve-Rosemont and serves as an Associate Clinical Professor at the University of Montreal, where she mentors residents and international fellows. Dr. Talajic also holds a Master’s in Public Health from Johns Hopkins and has published extensively on lamellar corneal surgery.

References

Stone DU, Chodosh J. Oral tetracyclines for ocular rosacea: an evidence-based review of the literature. Cornea. 2004;23,106-109. doi:10.1097/00003226-200401000-00020 DOI: https://doi.org/10.1097/00003226-200401000-00020

Jabbehdari S, Caughlin B, Memar OM, Djalilian AR. Update on the pathogenesis and management of ocular rosacea: an interdisciplinary review. Eur J Ophthalmol. 2021;31,22-33. doi:10.1177/1120672120937252

Donaldson KE, Karp CL, Dunbar MT. Evaluation and treatment of children with ocular rosacea. Cornea. 2007;26,42-46. doi:10.1097/ICO.0b013e31802e3a54 DOI: https://doi.org/10.1097/ICO.0b013e31802e3a54

Akpek EK, Merchant A, Pinar V, Foster CS. Ocular rosacea: patient characteristics and follow-up. Ophthalmology. 1997;104:1863-1867. DOI: https://doi.org/10.1016/S0161-6420(97)30015-3

Vieira ACC, Höfling-Lima AL, Mannis MJ. Ocular rosacea: a review. Arquivos Brasileiros de Oftalmologia. 2012;75(5):363-369. doi:10.1590/s0004-27492012000500016 DOI: https://doi.org/10.1590/S0004-27492012000500016

Redd TK, Seitzman GD. Ocular rosacea. Curr Opin Ophthalmol. 2020;31(6):503–507. doi:10.1097/ICU.0000000000000706 DOI: https://doi.org/10.1097/ICU.0000000000000706

Tavassoli S, Wong N, Chan E. Ocular manifestations of rosacea: a clinical review. Clin Exp Ophthalmol. 2021;49(2):104-117. doi:10.1111/ceo.13900

Nazir SA, Murphy S, Siatkowski RM, Chodosh J, Siatkowski RL. Ocular rosacea in childhood. Am J Ophthalmol. 2004;137(1):138-144. doi:10.1016/s0002-9394(03)00890-0 DOI: https://doi.org/10.1016/S0002-9394(03)00890-0

Liang H, Randon M, Michee S, Tahiri R, Labbe A, Baudouin C. In vivo confocal microscopy evaluation of ocular and cutaneous alterations in patients with rosacea. Br J Ophthalmol. 2017;101(3):268-274. doi:10.1136/bjophthalmol-2015-308110 DOI: https://doi.org/10.1136/bjophthalmol-2015-308110

Gallo RL, Granstein RD, Kang S, Mannis M, Steinhoff M, Tan J, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-155. doi:10.1016/j.jaad.2017.08.037 DOI: https://doi.org/10.1016/j.jaad.2017.08.037

An HJ, Ninonuevo M, Aguilan J, Liu H, Lebrilla CB, Alvarenga LS, et al. Glycomics analyses of tear fluid for the diagnostic detection of ocular rosacea. J Proteome Res. 2005;4(6),1981-1987. doi:10.1021/pr0501620 DOI: https://doi.org/10.1021/pr0501620

Abokwidir M, Feldman SR. Rosacea management. Skin Appendage Disord. 2016;2(1-2):26-34. doi:10.1159/000446215 DOI: https://doi.org/10.1159/000446215

Tavassoli S, Wong N, Chan E. Ocular manifestations of rosacea: a clinical review. Clin Exp Ophthalmol. 2021;49:104-117. doi:10.1111/ceo.13900 DOI: https://doi.org/10.1111/ceo.13900

Geng RS, Slomovic J, Bourkas AN, Slomovic AR, Sibbald RG. Ocular rosacea: the often‐overlooked component of rosacea. JEADV Clinical Practice. 2024;3:1349-1363. doi: 10.1002/jvc2.428 DOI: https://doi.org/10.1002/jvc2.428

Wladis EJ, Adam AP. Current and emerging therapies for ocular rosacea. US Ophthalmic Review. 2013;6:86. doi: 10.17925/USOR.2013.06.02.86 DOI: https://doi.org/10.17925/USOR.2013.06.02.86

Jabbehdari S, Memar O, Caughlin B, Djalilian AR. Update on the pathogenesis and management of ocular rosacea: an interdisciplinary review. Eur J Ophthalmol. 2020;31(1):22-33. doi:10.1177/1120672120937252 DOI: https://doi.org/10.1177/1120672120937252

Pellegrini F, Vincigiuerra A, Maria A. Spontaneous bilateral corneal perforation in ocular rosacea. Eur J Ophthalmol. 2024;34(3):NP5-NP7. doi:10.1177/11206721231212087 DOI: https://doi.org/10.1177/11206721231212087

Korting HC, Schöllmann C. Tetracycline actions relevant to rosacea treatment. Skin Pharmacol Physiol. 2009;22(6):287-294. doi:10.1159/000235550 DOI: https://doi.org/10.1159/000235550

Sobolewska B, Doycheva D, Deuter C, Pfeffer I, Schaller M, Zierhut M. Treatment of ocular rosacea with once-daily low-dose doxycycline. Cornea. 2014;33(3):257-260. doi:10.1097/ICO.0000000000000051 DOI: https://doi.org/10.1097/ICO.0000000000000051

Syed YY. Lotilaner Ophthalmic solution 0.25%: first approval [published correction appears in Drugs. 2023;83(16):1543. doi: 10.1007/s40265-023-01965-7.]. Drugs. 2023;83(16):1537-1541. doi:10.1007/s40265-023-01947-9 DOI: https://doi.org/10.1007/s40265-023-01947-9

Talha M, Haris Ali M, Fatima E, Nadeem A, Ahmed A, Nashwan AJ. Efficacy and safety of Lotilaner ophthalmic solution (0.25%) for the treatment of demodex blepharitis: a GRADE assessed systematic review and meta-analysis of observational & experimental studies. Am J Ophthalmol. 2024;264:8-16. doi:10.1016/j.ajo.2024.03.019 DOI: https://doi.org/10.1016/j.ajo.2024.03.019

Gonzalez-Salinas R, Massaro-Corredor M, Quiroz-Mercado H, Ramos-Betancourt N, Ceballos JC, Baba SN, et al. Safety and efficacy of topical Lotilaner ophthalmic solution 0.25% for the treatment of demodex blepharitis: a pilot study. J Ophthalmol. 2021; 2021:3862684. doi:10.1155/2021/3862684 DOI: https://doi.org/10.1155/2021/3862684

Sadri E, Paauw JD, Simmons B, Meyer J, Yeu E, Berdy GJ, et al. Long-term outcomes of 6-week treatment of Lotilaner ophthalmic solution, 0.25%, for demodex blepharitis: a noninterventional extension study. Cornea. 2024;43(11):1368-1374. doi:10.1097/ICO.0000000000003484 DOI: https://doi.org/10.1097/ICO.0000000000003484

Wladis EJ. Intraductal meibomian gland probing in the management of ocular rosacea. Ophthalmic Plast Reconstr Surg. 2012;28(6),416-418. doi:10.1097/IOP.0b013e3182627ebc DOI: https://doi.org/10.1097/IOP.0b013e3182627ebc

Kim BY, Moon HR, Ryu HJ. Comparative efficacy of short-pulsed intense pulsed light and pulsed dye laser to treat rosacea. J Cosmet Laser Ther. 2019;21(5):291-296. doi:10.1080/14764172.2018.1528371 DOI: https://doi.org/10.1080/14764172.2018.1528371

Schroeter CA, Haaf-Von Below S, Neumann HAM. Effective treatment of rosacea using intense pulsed light systems. Dermatol Surg. 2006;31(10):1285-1289. doi:10.1111/j.1524-4725.2005.31204 DOI: https://doi.org/10.1111/j.1524-4725.2005.31204

Dell SJ. Intense pulsed light for evaporative dry eye disease. Clin Ophthalmol. 2017;11:1167–1173. doi:10.2147/OPTH.S139894 DOI: https://doi.org/10.2147/OPTH.S139894

Vora GK, Gupta PK. Intense pulsed light therapy for the treatment of evaporative dry eye disease. Curr Opin Ophthalmol. 2015;26(4):314-318. doi:10.1097/ICU.0000000000000166 DOI: https://doi.org/10.1097/ICU.0000000000000166

Neuhaus IM, Zane LT, Tope WD. Comparative efficacy of nonpurpuragenic pulsed dye laser and intense pulsed light for erythematotelangiectatic rosacea. Dermatol Surg. 2009;35(6):920-928. doi:10.1111/j.1524-4725.2009.01156.x DOI: https://doi.org/10.1111/j.1524-4725.2009.01156.x

Fishman HA, Shah AA, Periman LM. Real-Time Video Microscopy of In Vitro Demodex Death by Intense Pulsed Light. Photobiomodul Photomed Laser Surg. 2020;38(8):472-476. doi:10.1089/photob.2019.4737 DOI: https://doi.org/10.1089/photob.2019.4737

Son M, Kang D, Oh S, Choi J, Shim M, Park J, et al. Radiofrequency irradiation attenuates angiogenesis and inflammation in UVB-induced rosacea in mouse skin. Exp Derm. 2020;29(7):659-666. doi:10.1111/exd.14115 DOI: https://doi.org/10.1111/exd.14115

Vassileva S, Tanev I, Drenovska K. Rosacea: the eyes have it. Clin Dermatol. 2023;41(4):528-536. doi:10.1016/j.clindermatol.2023.08.009 DOI: https://doi.org/10.1016/j.clindermatol.2023.08.009

Downloads

Published

2025-08-11

How to Cite

1.
May Tal A, Choremis J, Talajic JC. Unmasking Ocular Rosacea: Diagnostic Challenges and Evolving Management. Can Eye Care Today [Internet]. 2025 Aug. 11 [cited 2025 Aug. 18];4(2):29–34. Available from: https://canadianeyecaretoday.com/article/view/4-2-May-Tal_et_al

Issue

Volume 4, Issue 2, Summer 2025

Section

Articles

License

Copyright (c) 2025 Canadian Eye Care Today

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Most read articles by the same author(s)