Rosacea Review - Newsletter of the National Rosacea SocietyRosacea Review - Newsletter of the National Rosacea Society

Ocular Rosacea Can Threaten Sight

While red, teary or scratchy eyes might sometimes be shrugged off as simple irritation from harsh winter weather, these may actually be warning signs of ocular rosacea, a potentially serious condition that many people do not associate with a skin disorder.

"The effects of rosacea on the eyes may easily be overlooked because they often develop after, and sometimes before, the disorder affects the skin," said Dr. Bryan Sires, associate professor and acting chair of ophthalmology at the University of Washington. "In most cases, ocular rosacea is a mild, irritating condition, but it can develop into a permanently debilitating one -- including loss of vision -- without proper care."

Although as many as 58 percent of rosacea patients have been found to have ocular symptoms in clinical studies, he noted that the condition may be easily controlled if diagnosed and treated before it becomes severe.

An eye affected by rosacea often appears to be watery or bloodshot. Patients may feel a gritty or foreign body sensation in the eye, or have a dry, burning or stinging sensation.

Dr. Sires added that in the majority of ocular rosacea patients, beyond mild irritation there is a feeling of fullness in the eyelid. This is often the result of thickened secretions of the meibomian or Zeis glands along the eyelid margin. The fatty secretions help to avoid evaporation of the watery layer of the tears. The plugging of these glands may lead to dry eye or styes, both common manifestations of ocular rosacea.

"Severe symptoms result when the cornea becomes infected," he said. "These patients have a deep boring pain. At this point, an aggressive treatment approach is necessary to avoid the need for a more invasive procedure like corneal transplantation."

Left untreated, patients with severe ocular rosacea could endure scarring within the eyelid, vision loss from corneal ulcers and potential loss of the eye if an ulcer progresses beyond the cornea.

Ocular rosacea is diagnosed by an overall examination of both the facial skin and eyes. Ophthalmologists also frequently use a biomicroscope, which allows the detection of tiny visible blood vessels along the eyelid margin and any plugging of the meibomian glands -- both signs of ocular rosacea.

Treatment for ocular rosacea is typically a combination of local and systemic therapy as well as cleansing and tearing agents, all of which may be adjusted over time.

For mild cases, patients are often instructed to use warm compresses several times a day on the eyelids. Lid hygiene may include gentle cleansing with a Q-Tip and baby shampoo. For moderate cases, topical medications may be prescribed, along with eye drops for lubrication.

"For more severe cases, patients are placed on oral antibiotics such as doxycycline," Dr. Sires said. "This is at regular doses for a two-week period and then at a maintenance dose for several months thereafter."

As with facial rosacea, ocular rosacea patients are also encouraged to identify and avoid any lifestyle or environmental factors that may trigger or aggravate their individual condition. Common trigger factors include emotional stress, hot or cold weather, wind, spicy food, alcohol, heated beverages and many others.