Ocular Rosacea

By Dr. Ananya Mandal, MDReviewed by Sally Robertson, B.Sc.

Rosacea primarily affects the skin of the face and sometimes neck and leads to flushing and persistent redness of the face. With time, rosacea may cause deformities of the facial skin and nose (rhinophyma).

The condition affects a large number of people worldwide and is severely disfiguring. There are several environmental and lifestyle triggers that bring about flare-ups of this condition and treatment mainly focuses on avoiding these triggers as there is no fixed cure for this condition.

One of the dreaded and under-diagnosed conditions associated with rosacea is eye involvement of the disease or ocular rosacea, which may potentially blind a patient.

Around 80% of patients with rosacea develop ocular rosacea as a complication. However, ocular rosacea may be a standalone condition with no skin symptoms.

Symptoms of Ocular Rosacea

• Gritty Sensation of grit or sand within the eye
• Increased sensitivity to light or photophobia
• Eye pain
• Itching of the eyes
• Redness of the conjunctiva with prominence of blood vessels over the whites of the eyes
• Increased watering of the eyes
• Swelling of the lids and redness of the eyelids (blepharitis)
• Irregularity of lid margins
• Dysfunction of the eye glands
• In around 13% of cases the condition may affect the cornea or the central transparent part of the eye that allows vision
• Low visual acuity of below 20/200 is seen in around 5% of the patients

Causes

As with  rosacea, the causes of ocular rosacea are not clearly known. Some of the speculated causes of the condition include those similar to skin rosacea:

• Genetic predisposition
• Infection with the bacteria Helicobacter pylori
• Infestation with the parasite Demodex folliculorum
• Seborrhea or dandruff

Due to ocular rosacea, the thin layer of lipids or fats over the eye is disrupted and this leads to dry eyes. Dry eyes trigger inflammatory responses leading to itching, watering and redness of the eyes.

Prevention and treatment

To prevent ocular rosacea, patients with rosacea are advised to avoid triggers that cause flare-ups of the disease. They are also advised to avoid things that aggravate eye inflammation and dry eyes including corneal surgery and contact lenses. Other factors to be avoided include toxic environmental factors, heat, cold, wind, and smoke.

Treatment includes:

• Warm compresses and eye lid massage and a routine eye lid cleaning
• Use of lubricants or artificial tears to prevent dry eyes
• Tetracyclines or doxycycline
• Prescription eye drops or ointments containing steroids

One of the possible complications of ocular rosacea if left untreated is blindness due to scarring over the cornea.

Further Reading

• All Rosacea Content
• Rosacea - Facial Redness
• Rosacea Symptoms
• Rosacea Epidemiology
• Rosacea Subtypes