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| Does this look like your eye? A little red, a little irritated, red rims along the lash margin? That's the calling card of chronic inflammation caused by ocular rosacea (a type of chronic dry eye). via |
The study followed 38 patients with diagnosed rosacea and ocular rosacea signs and symptoms. The group was split evenly with 19 patients being started on Restasis eye drops taken twice daily for 3 months, and the other 19 patients being placed on 100 mg oral doxycycline taken twice daily for one month, then once daily for the two months. All patients were instructed to use daily eyelid hygiene and artificial tears 4 times a day throughout the study period. Before the study began and then monthly thereafter, patients were scored on symptoms (burning? watering?) and clinical signs (eyelid redness? corneal staining?) by a group of ophthalmologists. Standard protocol dry eye testing was also performed at these visits, including OSDI surveys, Schirmer's Test and tear break up time.
Symptom, eyelid sign and corneal/conjunctival sign panel of patients in cyclosporine and doxycycline treatment groups at baseline and 3mo after treatments
| Patients' signs and symptoms | Restasis (n=19) | Doxycycline (n=19) | ||
| Baseline | 3mo after treatment | Baseline | 3mo after treatment | |
| Symptoms | ||||
| Burning | 19 (100.0) | 4 (21.1) | 19 (100.0) | 14 (73.7) |
| Stinging | 19 (100.0) | 9 (47.3) | 19 (100.0) | 14 (73.7) |
| Itching | 11 (57.9) | 4 (21.1) | 16 (84.2) | 8 (42.1) |
| Photophobia | 19 (100.0) | 2 (10.5) | 18 (94.7) | 4 (21.1) |
| Redness | 18 (94.7) | 4 (21.1) | 19 (100.0) | 9 (47.3) |
| Blurred vision | 8 (42.1) | 1 (5.3) | 6 (31.6) | 1 (5.3) |
| Watering | 17 (89.5) | 6 (31.6) | 17 (89.5) | 6 (31.6) |
| Pain | 11 (57.9) | 1 (5.3) | 7 (36.8) | 4 (21.1) |
| Lid swelling | 10 (52.6) | 0 (0.0) | 6 (31.6) | 2 (10.5) |
| Eyelid Signs | ||||
| Meibomian gland inspissation | 19 (100.0) | 8 (42.1) | 19 (100.0) | 14 (73.7) |
| Blepharitis | 18 (94.7) | 3 (15.8) | 19 (100.0) | 10 (52.6) |
| Lid margin telangiectasia | 14 (73.7) | 3 (15.8) | 17 (89.5) | 11 (57.9) |
| Hordeola/chalazia | 4 (21.1) | 0 (0.0) | 5 (26.3) | 0 (0.0) |
| Lid margin irregularity | 12 (63.2) | 3 (15.8) | 11 (57.9) | 5 (26.3) |
| Corneal /Conjonctival Signs | ||||
| Conjuctival hyperemia | 19 (100.0) | 5 (26.3) | 19 (100.0) | 12 (63.2) |
| Punctate keratopathy | 18 (94.7) | 0 (0.0) | 15 (78.9) | 0 (0.0) |
| Corneal vascularization | 3 (15.8) | 3 (15.8) | 2 (10.5) | 2 (10.5) |
| Episcleritis/scleritis | 17 (89.5) | 2 (10.5) | 18 (94.7) | 3 (15.8) |
| Corneal infiltrates | 3 (15.8) | 1 (5.3) | 2 (10.5) | 1 (5.3) |
| Corneal ulceration/perforation | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
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| Red, inflamed meibomian glands can't secrete tear film regularly as you blink, causing dryness, burning, watering, and foreign body sensation. That's why a vital part of dry eye treatment includes lid hygiene and chronic use of anti-inflammatory medications, be they topical like Restasis or oral like doxycycline. |
In addition to better performances in several categories of dry eye assessment, Restasis also has the luxury of having a better safety profile. The most common side effect of Restasis is burning upon instillation, while oral doxycycline has the risk of causing increased risk for sunburns and stomach upset. Neither Restasis or doxycylcine can be used in pregnant or nursing mothers. Because rosacea as a condition is chronic, using a drop like Restasis year round may be better suited than intermittent doxycycline pulses to control symptoms long term. Another point of interest is that studies repeatably show Restasis performs even better at month 6 and month 12 than it does after just 3 months of use, so if the study had been extended out it would be interesting to see if Restasis users continued to have larger and larger improvements.
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