Ocular Rosacea is an inflammatory eye condition often associated with acne rosacea. Ocular rosacea can cause a persistent burning or gritty feeling in the eyes. For others, ocular rosacea manifests itself as inflamed and swollen eyelids with small inflamed bumps, eyelashes that may fall out, compounded by bloodshot eyes (Dr. Thiboutot). The ophthalmic signs of ocular rosacea can vary widely, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. (These conditions will be described in detail below.) The term ophthalmic or ocular rosacea covers all these signs. The most frequent signs, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts, quite similar to seborrheic dermatitis, with which ocular rosacea is often confused. Pain and photophobia (abnormal sensitivity to light) may be present. The ocular complications are independent of the severity of facial rosacea (Drs. Gerd Plewig & Albert M. Kligman).
It is reported that 50 to 60% of all rosacea sufferers also have some sort of symptoms with their eyes which is known as ocular rosacea. In one study (Starr, McDonald 1969) it was found that ocular rosacea symptoms occurred in 58% of patients.
Sometimes (perhaps 20% of the time) ocular rosacea problems occur prior to the typical skin related rosacea symptoms though it is more usual (about 53% of the time) for the skin symptoms to appear first. (Borrie, 1953).
Ocular rosacea patients generally have chronically "bloodshot" eyes, dry eyes, and blepharitis (inflammation and debris of the eyelid margins). In severe ocular rosacea, there may be corneal ulceration (infection) which, if untreated, may even lead to perforation of the eye. This can be a potentially blinding complication.
People with rosacea have a tendency to be overall more dehydrated than others. The body is approximately 65% water while the eye is 96% water. Increasing your water intake will increase the moisture in the eye (thereby decreasing irritation and dryness). It has been found that increasing the amount of water consumed daily can ease the symptoms of ocular rosacea for many.
The dry eye syndrome, which often accompanies ocular rosacea, can also be treated with non-preserved artificial tears, as often as 4 times a day or more. Another ocular treatment is a home humidifier which may also add valuable moisture to the air. If these treatments for the symptoms of ocular rosacea are not sufficient, more drastic treatments may be needed. One such ocular treatment involves closure of the tear drainage ducts which is accomplished with silicone plugs, which are reversible, or punctal cautery (a burning of the tear duct openings), which is a relatively permanent ocular treatment.
Blepharitis is a common inflammatory ocular condition that affects the eyelids. It usually causes burning, itching and irritation of the lids. Other common symptoms include sandy, itchy eyes, red and/or swollen eyelids, crusty, flaky skin on the eyelids, and dandruff. In severe cases, this ocular condition may also cause sties, irritation and inflammation of the cornea (keratitis) and conjunctiva (conjunctivitis). Some patients have no ocular symptoms at all. Blepharitis, usually a chronic problem, can be controlled with extra attention to lid hygiene. However, it may also be caused by an infection which would require treatment with a prescription medication.
The key to controlling blepharitis is to keep the eyelids and eyelashes clean. Home treatment should begin by soaking a clean washcloth in hot tap water. Place the compress on closed eyelids for five minutes, and then repeat. Next, gently scrub the eyelids with a washcloth or cotton swab soaked in a mixture of equal parts of baby shampoo and water. Afterward, rinse the lids thoroughly with warm water.
This treatment may need to be repeated two to three times daily for two weeks, and then reduced to once daily. Like dandruff, there is no cure for blepharitis; but with treatment, it can be controlled. Anti-inflammatory and antibiotic treatment drops or ointments may be necessary for flare-ups or more severe cases. Remember to remove all mascara before going to bed.
Red, painful eyes may be the result of conditions known as episcleritis and scleritis. Both conditions involve inflamed blood vessels in the eye.
Keratitis is one of the more serious conditions which may occur in relation to ocular rosacea. Keratitis is a term used to cover a range of ocular conditions where there is infection or inflammation of the cornea. This condition may result in severe eye pain, blurry vision and sensitivity to light. Medical evaluation and treatment of keratitis is absolutely essential. Minor corneal infections are commonly treated with anti-bacterial or anti-fungal eye drops. If the problem is more severe, a person may receive more intensive antibiotic treatment to eliminate the infection and may even require steroid eye drops to reduce inflammation.
Iritis is an inflammation of the iris, a part of the eye. Symptoms include eye pain, sensitivity to light, and/or blurry vision. The symptoms of this may resemble conjunctivitis.
Sties can also occur in ocular rosacea. The best treatment for a stye is a warm compress. Apply a warm, moist washcloth to your lids for 5 minutes, four times a day. Following this treatment, within a few days the infection will either die down or come to a head and drain.
Chalazia, or bumps on eyelids, may also be a problem. Hot packs are the best treatment for these infections. However, if the bump fails to go away in a month it may be necessary to drain it. This treatment is done in your Ophthalmologist's office.
Treatment of ocular rosacea requires a highly motivated patient. With regard to ocular rosacea, treatment usually consists of lid hygiene measures, such as daily cleansing with cotton-tipped applicators (Q-tips). This entails cleansing the bases of the lashes with a moistened Q-tip to remove debris and oily secretions. Some ophthalmologists advocate cleansing with diluted baby shampoo, while others believe that plain water is best. Often, an antibiotic or combination antibiotic-steroid ointment is prescribed for various periods of time, depending on response.
We also have found it beneficial to include in your diet three servings per week from the Omega-3 supplements. These essential fatty supplements aid in an overall balanced diet as well as easing the discomfort of ocular rosacea.
Antibiotics from the tetracycline family such as Doxycycline and Minocycline are often prescribed to bring symptoms of ocular rosacea under control. Studies of the use of Doxycycline by patients with ocular rosacea showed significant improvement with a variety of signs/symptoms including dryness, itching, blurred vision and photosensitivity, scales, erythema and telangiectasis (Quarterman 1997)
For dry eyes, some rosacea sufferers use Celluvisc Eye treatment drops found at drug stores or grocery stores. They are much thicker than the usual eye drops and can be used without taking out contact lenses. Because of the thickness of the eye drops, they may temporarily impair vision.
