Ocular Rosacea
Ocular rosacea is related to a common inflammatory condition affecting skin of the face and chest, as well as the eyes. While the exact cause of rosacea is unknown, the condition may be associated with inherited tendencies and environmental factors such as excessive sun exposure.
Rosacea occurs more frequently in women, but men are more likely to have severe forms of the disease. Eye involvement with rosacea is not unusual, although there is no definitive study indicating just how many people have eye or eyelid problems when they are diagnosed with the skin condition.
Studies have indicated that between 6% and 18% of people diagnosed with acne rosacea — so named because it resembles acne — also have ocular symptoms.* Other reports say the number of rosacea patients with eye symptoms could be as high as 60%.
Rosacea itself seems to occur in just over 5% of the global population.
Symptoms of Rosacea and Ocular Rosacea
People with rosacea often have a "ruddy" complexion in the early stages, such as a reddish nose and cheeks. These symptoms often progress to include development of bumpy red skin lesions, pimples and tiny, tortuous vessels in the skin known as telangiectasias.
The most severe cases of rosacea progress to a condition called rhinophyma, in which the skin thickens along with connective tissues of the nose. Rhinophyma can result in some degree of disfigurement.
When you have rosacea affecting the skin, you may not realize that your eyes are also involved if accompanying symptoms such as eye itchiness and eye redness are relatively mild.
People diagnosed with ocular rosacea commonly have chronically bloodshot eyes, dry eyes and blepharitis (eyelid inflammation).
Ocular rosacea can also cause photophobia (unusual sensitivity to light), so if you are bothered by bright light, ask your eye care professional about photochromic lenses that automatically darken in response to sunlight.
In cases of severe ocular rosacea, inflammation of the cornea may lead to a corneal ulcer with infection. If left untreated, the corneal ulcer may even perforate the eye. This is a serious and potentially sight threatening complication.
Treatments for Ocular Rosacea
Effective treatment of rosacea requires a highly motivated patient willing to devote the time it takes to control the condition.
When ocular rosacea is present, treatment usually consists of eyelid hygiene measures that include daily cleansing:
Moistened cotton swabs can remove debris and oily secretions.
Specific lid hygiene products are available, speak to your eye care professional for a treatment plan
Often, an antibiotic or combination antibiotic-steroid ointment is prescribed for varying periods of time, depending on response. For example, tetracyclines tend to work well for rosacea, not only because of the antibiotic effect, but because tetracyclines tend to decrease the viscosity of naturally secreted oils, thereby reducing the oil gland "plugging" that occurs with the disease.
Most eye care professionals will prescribe long-acting tetracyclines such as doxycycline, which can be taken once or twice a day. Furthermore, doxycycline, unlike traditional tetracycline, can be taken with food and milk products without preventing absorption in the body.
If you have rosacea, avoid triggers — such as spicy foods and alcohol — that can cause inflammation.
Dry eye syndrome, which often accompanies rosacea, should be treated with non-preserved artificial tears (eye drops) as often as four times a day or more. A home humidifier may also help.
If these measures are insufficient, punctal plugs can easily close the tear drainage ducts. While punctal plugs can be removed if necessary, another possible measure is punctal cautery (burning of the tear duct openings), which is relatively permanent.
Finally, topical metronidazole (an anti-parasitic agent) may be used on the skin and in many people, it is very effective in treating rosacea-related dermatitis. The medicine appears to have local anti-inflammatory and immunosuppressive effects. Because this treatment is not available in ophthalmic preparations, you should not apply the medicine directly to your eyelids.
If you have ocular rosacea, your eye care professional will likely advise you to avoid triggers that may cause inflammation, such as stress, spicy foods and alcohol.
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Marilyn Haddrill also contributed to this article.
**Systemic review of rosacea treatments. Journal of the American Academy of Dermatology. January 2007.
*Ocular rosacea: an update on pathogenesis and therapy. Current Opinion in Ophthalmology. December 2004.
Page published on Wednesday, 16 March 2022
