Rosacea is one of the most common systemic conditions I see in my patients that affects their eyes (ocular rosacea). 80% of rosacea patients have meibomian gland dysfunction. 86% of dry eye is evaporative in nature and a result of meibomian gland dysfunction. Based on this information you would think that if you had rosacea you would definitely be seeking treatment for dry eye. Unfortunately, this is not the case and even more surprisingly, a lot of patients with mild rosacea do not know they have it. I want to give an overview of what it is and how it can affect your eyes.
I am going to be covering:
- What Rosacea is
- Common Triggers
- Symptoms of Ocular Rosacea
- Signs of Ocular Rosacea
- Treatment Options
What is Rosacea?
Rosacea is primarily an inflammatory skin condition that affects the cheeks, chin, nose, and central forehead. It is known for causing redness and abnormal blood vessel growth. Symptoms include: frequent blushing or flushing, persistent redness, and the presence of telangiectasias or abnormal blood vessel growth. This can lead to burning or stinging sensations, dry appearance, edema, and ocular manifestations.
Triggers
There are a number of things that can trigger rosacea flare ups. These include genetic and environmental factors. I am going to focus on the environmental factors as there is little we can do about our genetics. The environmental factors include: UV exposure, bacteria (demodex), heat exposure, emotional stress, and certain medications such as chronic use of corticosteroids.
Ocular Rosacea – Symptoms
When I am doing an eye examination, I am always doing a thorough case history to see if patients are taking any medications that may be related to rosacea and looking at their entire face for signs of redness or blood vessel growth. However, these symptoms often lead me to the diagnosis: blurred vision, red watery eyes, burning or stinging, and light sensitivity.
Ocular Rosacea – Signs
Upon examination, I almost always see signs of blepharitis or debris in their lashes and their lid margins. They have meibomian gland dysfunction which is when the glands of their eyelids are inflamed and obstructed. This leads to an unstable tear film and evaporative dry eye. When left untreated this leads to chronic conjunctivitis and issues with the cornea such as infections and scarring.
Treatment Options – Intense Pulse Light Therapy
In order to treat systemic rosacea dermatologists have used doxycycline, isotretinoin, and they have a toolbox of topical agents at their disposal. In regards to ocular rosacea, we want to avoid environmental triggers, reduce inflammation, and eliminate the bacterial component on the lids and lashes. Intense pulse light therapy (IPL) is FDA approved for the treatment of dry eye and it has been shown to reduce inflammation by getting rid of abnormal blood vessels and their inflammatory markers, eliminating the demodex bacteria found in the lids and lashes, and helping restore the meibomian glands back to their original function.
Complex and Chronic Condition
As you can see rosacea and specifically, ocular rosacea, is a complex condition that directly affects the eyes. There are a plethora of treatment options for patients. The key to success is knowing you have the condition and making sure your eye doctor is aware of it and educated in how to properly treat the inflammation, bacteria, and obstruction of your lids and lashes. Click here to schedule an appointment with us and get your dry eye under control!