Eyelid Warming Device, Azithromycin Drops Improve Pediatric Ocular Rosacea

A combined treatment consisting of eyelid warming and azithromycin 1.5% may improve ocular rosacea signs in pediatric patients.

Combined treatment using an eyelid warming device, eyelid hygiene and azithromycin 1.5% eye drops is well-tolerated in children and improves signs and symptoms of pediatric ocular rosacea within 3 to 4 weeks, according to a study published in Journal Français d’Ophtalmologie

Researchers retrospectively reviewed the medical histories of 6 children diagnosed with ocular rosacea who visited a single center between 2009 and 2015. Participants discontinued all previous ocular rosacea treatments and underwent 1 or 2 daily treatment sessions consisting of 10 minutes with an eyelid-warming device followed by eyelid massage and cleansing. Patients underwent a 3-day treatment regimen of azithromycin 1.5% for inflammation control over a 10-day period. Treatment was reduced to a 3-day regimen over 2 weeks and eventually, a 3-day treatment over 1 month upon demonstration of clinical efficacy.

After a detailed ophthalmic assessment, ocular rosacea was diagnosed with an average delay of 37.5 months (range, 5-144 months), according to the report. All patients presented with corneal sequelae and reduced vision. Ocular manifestations included meibomian gland disease, recurrent chalazia, and phlyctenular keratoconjunctivitis, the report shows. 

The researchers noted that cutaneous signs were not always related to the condition and stated that ocular rosacea is typically resistant to initial treatments with antibiotics and topical corticosteroids. The team reported a rapid improvement in signs and symptoms of ocular rosacea within 3 to 4 weeks after the children were treated with the eyelid warming device and topical azithromycin 1.5%. They also report that the treatment is well tolerated by children. 

In this study, azithromycin 1.5% eye drops were used as an alternative and resulted in a rapid improvement in conjunctival hyperemia and eyelid inflammation.

“In pediatrics, the use of oral antibiotics such as tetracycline, erythromycin and doxycycline, and/or anti-inflammatory agents, should be limited due to the associated side effects,” according to the researchers. “In this study, azithromycin 1.5% eye drops were used as an alternative and resulted in a rapid improvement in conjunctival hyperemia and eyelid inflammation.”

Study limitations include a retrospective design, small sample size, and the inclusion of concomitant treatments heterogeneously in addition to the eyelid warming device.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or clinical research organizations. Please see the original reference for a full list of authors’ disclosures.


Brémond-Gignac D, Navel V, Doan S, Chiambaretta F. Paediatric ocular rosacea: diagnosis and management with an eyelid-warming device and topical azithromycin 1.5%. J Fr Ophthalmol. Published online October 29, 2022. doi:10.1016/j.jfo.2022.01.003