How to treat my worsening rosacea at age 52?

Question

Hi doctor,

My rosacea has gotten progressively worse since menopause started 2 years ago and is now affecting my eyes too, which is really scary.

I am 52, and the facial flushing and burning sensation happen multiple times daily, especially with hot flashes. I tried metronidazole gel for months, but it barely made any difference, and the redness keeps spreading from my cheeks to my nose and forehead. Now getting these inflammatory papules that look like acne but hurt when I touch them.

The worst part is my eyes are constantly red and dry and feel like there is sand in them; the ophthalmologist confirmed it is ocular rosacea. Cannot wear makeup anymore because everything stings and makes the inflammation worse.

Even gentle cleansers cause a burning sensation. I have been avoiding triggers like spicy food and wine, but the hormonal changes seem to make everything a trigger now.

What treatments work best for menopausal rosacea with eye involvement?
Are there any hormonal therapies that might help?

Please help.

Thank you.

Answer 1

Hello.

I can understand your concern, and it is completely understandable to feel overwhelmed when symptoms start affecting something as sensitive as your eyes. For your ocular rosacea, this typically requires:

Warm compresses and lid hygiene with diluted baby shampoo, artificial tears (preservative-free). Sometimes oral antibiotics, which often work better for eye symptoms than topical treatments. In severe cases, Cyclosporine eye drops can be used.

Regarding hormonal connections, some women do find that hormone replacement therapy (HRT) can help stabilize rosacea symptoms by reducing hot flashes and hormonal fluctuations. However, this needs careful discussion with your gynecologist, weighing the benefits against any personal risk factors.

It is worth bringing this up at your next appointment so you can make an informed decision together. Immediate skincare adjustments:

Use only mineral sunscreens (zinc oxide/titanium dioxide). Try very gentle, fragrance-free cleansers like Vanicream or CeraVe Hydrating Cleanser. Consider a bland moisturizer to repair your skin barrier

The eye symptoms are particularly important to address promptly with your ophthalmologist, as untreated ocular rosacea can potentially lead to corneal complications.

We understand it can feel like a lot to manage across multiple specialists, but having both dermatology and ophthalmology working together on your case really does make a difference.

We would recommend scheduling follow-ups with both dermatology and ophthalmology to discuss the more aggressive treatment options available for your situation. You are not alone in navigating this, and with the right care in place, things can improve meaningfully.

Take care, and please do not hesitate to reach out if you have any further questions.

Do follow up whenever needed.

Let me know if I can assist you further.

Thank you.