Rosacea Type 4

By: Vivacare - Dr. Mark Becker

Rosacea subtype 4, also called “ocular rosacea”, is a form of rosacea that affects the eyes and eyelids.

It is estimated that ½ of people with rosacea eventually develop ocular rosacea.

Ocular rosacea usually occurs after a person has developed rosacea on their face. However, ocular rosacea can occur before other rosacea symptoms appear on the skin.

Ocular Rosacea - Rosacea type 4

Images of A-mild, B-moderate and C-severe ocular rosacea 

Most cases of ocular rosacea start off with mild irritation of the eyes, including watery, itchy eyes and swollen eyelids, but these symptoms can progress and become more serious.

The glands that lubricate the eyelids (meibomian glands) may becomes blocked, resulting in dry eyes and scaly, crusty eyelids (blepharitis). Sties may also form or the eyelashes may fall out. The blood vessels within the iris of the eyes may also become dilated and inflamed, resulting in iritis. This can cause sensitivity to light.

One of the more serious eye conditions related to rosacea is keratitis, an inflammation and/or infection of the cornea. This is a serious condition that can lead to permanent eye damage and vision loss if not treated.

Treatment of rosacea subtype 4 (ocular rosacea)

A stepwise approach may be recommended for the treatment of ocular rosacea depending on the severity. Lid hygiene and artificial tears may be used first, followed by topical and oral anti-inflammatory medications. Multiple treatments may be used in combination for best results.

Lid hygiene: Hot compresses applied to the eyelid margins can help promote the flow of eyelid secretions from the meibomian glands. Mild, nonirritating cleaning solutions, such as dilute baby shampoo or commercially available eyelid scrubs, can be used to gently remove debris from the eyelids.

Artificial tears: Nonpreserved artificial tears can be used liberally throughout the day

Antibiotic eye ointment: If necessary, a lubricating antibiotic eye ointment may be used at night.

Oral antibiotics (tetracycline, doxycycline, minocycline, erythromycin). Oral doxycycline may be prescribed at a relatively low dose (anti-inflammatory doxycycline) to control the inflammation without leading to bacterial resistance that can occur at the higher doses usually prescribed to treat infections.


With good eye hygiene and prompt, consistent treatment, most cases of ocular rosacea can be effectively controlled. However, if left untreated, ocular rosacea symptoms can impair eyesight.

Images courtesy of the National Rosacea Society.