Ocular rosacea

Overview

Ocular rosacea (roe-ZAY-she-uh) is inflammation that causes redness, burning and itching of the eyes. It often develops in people who have rosacea, a chronic skin condition that affects the face. Sometimes ocular (eye) rosacea is the first sign that you may later develop the facial type.

Ocular rosacea primarily affects adults between the ages of 30 and 50. It seems to develop in people who tend to blush and flush easily.

There's no cure for ocular rosacea, but medications and a good eye care routine can help control the signs and symptoms.

Symptoms

Signs and symptoms of ocular rosacea can precede the skin symptoms of rosacea, develop at the same time, develop later or occur on their own. Signs and symptoms of ocular rosacea may include:

• Red, burning, itchy or watering eyes
• Dry eyes
• Grittiness or the feeling of having a foreign body in the eye or eyes
• Blurred vision
• Sensitivity to light (photophobia)
• Dilated small blood vessels on the white part of the eye that are visible when you look in a mirror
• Red, swollen eyelids
• Recurrent eye or eyelid infections, such as pink eye (conjunctivitis), blepharitis, sties or chalazia

The severity of ocular rosacea symptoms doesn't always match the severity of skin symptoms.

When to see a doctor

Make an appointment to see a doctor if you have signs and symptoms of ocular rosacea, such as dry eyes, burning or itchy eyes, redness, or blurred vision.

If you've been diagnosed with skin rosacea, ask your doctor whether you should undergo periodic eye exams to check for ocular rosacea.

Causes

The exact cause of ocular rosacea, like skin rosacea, is unknown. It may be due to one or more factors, including:

• Heredity
• Environmental factors
• Bacterial involvement
• Blocked glands in the eyelids
• Eyelash mites

Some research has also shown a possible link between skin rosacea and Helicobacter pylori bacteria, which is the same bacteria that causes gastrointestinal infections.

A number of factors that aggravate skin rosacea can aggravate ocular rosacea, as well. Some of these factors include:

• Hot or spicy foods or beverages
• Alcohol
• Sunlight, wind or temperature extremes
• Certain emotions, such as stress, anger or embarrassment
• Strenuous exercise
• Hot baths or saunas

Risk factors

Ocular rosacea is common in people with skin rosacea, although you can also have ocular rosacea without the skin being involved. Skin rosacea affects more women than men, and ocular rosacea affects men and women equally. It's also more common in fair-skinned people of Celtic and Northern European origin.

Complications

Ocular rosacea may affect the surface of your eye (cornea), particularly when you have dry eyes from evaporation of tears. Corneal complications can lead to visual symptoms. Inflammation of your eyelids (blepharitis) can cause secondary irritation of the cornea from misdirected eyelashes or other complications. Ultimately, corneal complications can lead to vision loss.

Diagnosis

No specific tests or procedures are used for diagnosing ocular rosacea. Instead, your doctor will likely make a diagnosis based on your symptoms, your medical history, and an examination of your eyes and eyelids, and the skin of your face.

Treatment

Ocular rosacea can usually be controlled with medication and home eye care. But these steps don't cure the condition, which often remains chronic.

Your doctor may prescribe temporary use of oral antibiotics, such as tetracycline, doxycycline, erythromycin and minocycline. For severe disease, you may need to take an antibiotic for a longer time.

Lifestyle and home remedies

You can help manage your ocular rosacea by following a good eye care routine. Keep up this routine even when your condition clears up to help prevent flare-ups. These tips may help.

• Keep your eyelids clean by gently washing them at least twice a day with warm water or a product your doctor recommends.
• Avoid makeup if your eyes are inflamed. When you're able to wear makeup, choose types that are nonoily (noncomedogenic) and free of fragrance.
• Avoid wearing contact lenses during flare-ups, especially if your symptoms include dry eyes.
• Prevent flare-ups by avoiding things that trigger or worsen your rosacea or ocular rosacea, if possible. Items that tend to dilate blood vessels in the face include hot, spicy foods and alcoholic beverages.
• Use artificial tears to relieve dryness. Ask your doctor for guidance.

Preparing for an appointment

You're likely to first see your family doctor or primary care provider. You may be referred to an eye specialist, such as an optometrist or an ophthalmologist.

Here's some information to help you prepare for your appointment.

What you can do

• List any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• If you've received a diagnosis of rosacea, be prepared to discuss your treatment history.
• List key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you're taking.
• List questions to ask your doctor.

Preparing a list of questions for your doctor can help you make the most of your time together. List your questions from most important to least important. For ocular rosacea, some basic questions to ask your doctor include:

• What is likely causing my symptoms?
• Do I need tests to confirm the diagnosis?
• Is my condition temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• I have other medical conditions. How can I best manage them together?
• Do I need to follow any restrictions?
• Is there a generic alternative to the medicine you're prescribing?

Don't hesitate to ask any other questions that arise during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Have you noticed any changes in your skin, such as redness, bumps or flushing?
• Have you noticed any changes in vision?
• What, if anything, seems to improve your symptoms?
• What, if anything, seems to trigger or worsen your symptoms?