The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Ocular rosacea is the manifestation in the eyes of rosacea, a chronic relapsing inflammatory skin condition that predominantly affects the cheeks, nose and forehead. It occurs in up to one in twenty people with peak incidence between the ages of 40 and 60. Patients can experience discomfort, dryness, photophobia and even blurred vision if the cornea is involved. Other clinical entities that are associated with rosacea such as blepharitis, tear film abnormalities and keratitis may be present. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating ocular rosacea. It provides recommendations for non-pharmaceutical management and pharmacological treatment, and highlights the need for urgent referral if keratitis is severe.
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What is ocular rosacea?
Rosacea is a common skin disorder that affects up to one in twenty people between the ages of 40 and 60 It can also affect the eye and cause redness of the nose, forehead and upper cheeks, along with inflammation of the oil glands of the skin. Around 50% of people with rosacea have eye involvement (termed ocular rosacea), with symptoms of discomfort, dryness and light sensitivity. The optometrist may find inflammation of the eyelids (blepharitis) and problems with the tear film (the thin layer of tears covering the surface of the eye) leading to patchy drying of the eye surface. This can cause inflammation of the cornea (the clear window at the front of the eye) with thinning, ulceration, ingrowth of abnormal blood vessels and scarring, all of which can lead to reduced vision.
How is ocular rosacea managed?
Dietary changes may help, as may attention to the inflammation of the eyelids. Artificial tears and lubricating ointments may relieve discomfort. An oral antibiotic, usually from the tetracycline family, can improve the condition of both the skin and the eyes. If the condition does not respond to simple measures such as these, the optometrist will refer the patient to the ophthalmologist (specialist eye doctor), who may consider prescribing other drugs and may possibly recommend surgery.
Ocular rosacea - 9 June 2026 The aetiology section has been amended to include the typical facial and periocular areas affected by rosacea together with additional environmental factors contributing to its pathology. The predisposing factors section has been updated to provide data on the prevalence of ocular rosacea in the presence of cutaneous rosacea. The symptoms section has been amended to include additional ocular and cutaneous symptoms that may be present in ocular rosacea. The non-pharmacological management section has been amended to include lifestyle advice aimed at preventing or reducing rosacea symptoms as well as the use of sunglasses to alleviate photophobia.
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