Ocular Rosacea

Rosacea is a dermatologic condition that affects the nose, cheeks, forehead, chin, and glabella (the area between the eyes and above the nose). More than 50% of patients with rosacea have ocular manifestations.

Ocular rosacea manifestations are essentially confined to the eyelids and ocular surface. Problems range from minor irritation, dryness, and blurry vision to potentially severe ocular surface disruption and inflammatory keratitis. Blepharitis and conjunctivitis are the most common findings in patients with ocular rosacea

Other ocular findings include lid margin and conjunctival telangiectasias (curly-cue blood vessels), eyelid crusting and scales, punctuate epithelial erosions, corneal infiltrates, corneal ulcers, and vascularization. Sight-threatening disease is rare with rosacea; however, keratitis can result in sterile corneal ulceration and eventual perforation if not treated aggressively.

The symptoms of rosacea can be treated effectively. Since rosacea is a chronic condition with exacerbations and remissions, long-term therapy to maintain symptomatic control is required.

Ocular rosacea is a syndrome of unknown cause. It is commonly misdiagnosed or undiagnosed. It usually has no previous family or personal history. It occurs at the greatest frequency in the 30- to 70- year age range, but may also be found in pediatric patients. Women are affected with rosacea twice as often as men. More than 10% of the general population exhibits dermatologic characteristics of rosacea; of these, up to 60% experience ocular complications. Approximately 5% of patients with rosacea manifest corneal disease, which may be severe and can lead to blindness via corneal ulceration, secondary infections, or corneal opacification from vascularization.

Usually, there exists a history of recurrent lid problems such as “styes”, chalazia, hordeoli, and chronic marginal blepharitis. Symptoms are usually synonymous with the level of involvement and associated complications. This is not contagious!

Treatment consists of daily lid hygiene. Hot compresses applied to the eyelid margins can help to liquefy the thick meibomian gland secretions and, thus, facilitate their expression. Mild, nonirritating cleaning solutions, such as diluted baby shampoo or commercially prepared eyelid scrubs, can be applied to the eyelids to remove clogging debris. Additionally, light pressure applied to the eyelids can aid in gland expression. Preservative free artificial tears should be used liberally throughout the day and, if necessary, a lubricating ointment may be used at night. Antibiotics may prove to be useful. Oral medications such as tetracycline, erythromycin, and topical skin creams such as metronidazole may be considered under doctor’s supervision. Topically, steroid drops have been proven helpful to reduce inflammation. Recently, newer topical drop therapy using AzaSite, Blephamide, Tobradex and Restasis may be used concurrently to create a greater effect.