Thursday, July 9, 2015

How to manage and treat Ocular Rosacea

Rosacea Illustrated - Photo © A.D.A.M.



Ocular Rosacea

A diagnosis of ocular rosacea is most easily determined if the patient also presents with the dermatological signs associated with acne rosacea- spider veins on nose and cheeks, however, in 20% of  cases, ocular rosacea can occur without skin evidences. This makes the diagnosis more complicated. 
Ocular rosacea is highly probable in people who report persistent eye and lid redness, a gritty or foreign body sensation or frequent styes (chronic dry eyes). Slit lamp signs typically include thickened lid margins with telangiectasia, thick, turbid meibomian gland secretions and tear film debris- Meibomian Gland Dysfunction.  . Crusting and scales in the lashes are also quite common. In severe cases, individuals can develop corneal erosions, infiltrates and ulcers, and even suffer vision loss due to substantial scarring and neovascularization.
Early diagnosis and aggressive management is important for maintaining ocular health and preventing vision loss. Management can range from warm compresses, lid scrubs and lubrication in mild cases, to pulsed ophthalmic corticosteroids, topical azithromycin (off-label) and oral tetracyclines (i.e. doxycycline and minocycline) in moderate to severe cases. Tetracyclines are typically dosed well below therapeutic concentrations, since the goal is to utilize its anti-inflammatory properties and not necessarily its antibiotic traits. Long-term maintenance with topical ophthalmic cyclosporin has also shown to be effective and prescribing lid scrubs containing tea tree oil may also help, as there appears to be a link between ocular rosacea and a bacterium (Bacillus oleronius) commonly found on Demodex mites. Regardless of the treatment, patients must understand that rosacea is a chronic condition and long-term therapy is required to maintain control and slow progression.

Symptoms of Rosacea.  

Individuals with ocular rosacea may not realize that they have dermatological (skin) disease (or vice versa) because signs and symptoms can be subtle. If your have  experienced them for a long time, you may not even realize it’s abnormal. Family history of dermatological problems, or if they experience facial flushing, especially when embarrassed or after eating spicy foods, drinking alcohol or sun exposure. Look for redness, bumps or small blood vessels on the cheeks, nose and forehead. A diagnosis of rosacea is not to be taken lightly — more than 90% of sufferers report lowered self-esteem, and 2/5 of patients say the condition has caused them to avoid public contact.4 A referral to a dermatologist can be very helpful. 

This is an abstract from Dry Eye News, July 2015. 

Theralife Can Help. 

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TheraLife® Eye works by restoring normal cell functions to both lacrimal and meibomian glands.  The result is balanced, sustainable tears from your own eye to provide comfort all day long.   Learn more
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1. National Rosacea Society. http://www.rosacea.org/class/classysystem.php (Accessed June 26, 2015)
2. Schechter BA, Katz RS, Friedman LS. Efficacy of topical cyclosporine for the treatment of ocular rosacea.
Adv Ther. 2009 Jun;26(6):651-9
3. Li J, O'Reilly N, Sheha H, et al. Correlation between ocular
Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea. Ophthalmology. 2010;117:870-877.
4. National Rosacea Society. http://rosacea.org/rr/2013/fall/article_3.php (Accessed June 26, 2015) 
This is an abstract from 

Wednesday, July 8, 2015

Do eye drops really relief chronic dry eyes?


A walk down any pharmacy “eye aisle” with a complaint of dryness can be a little overwhelming.  There are many different options, and their differences speak to the diversity of reasons one may be experiencing ‘dry eye’ in the first place.  Consequently, some seem more “effective” than others.
The basic story of dry eye syndrome is in the name, though its medical term – keratitis sicca – won’t tip you off in the same way.  When the surface of the eye lacks moisture and lubrication due to a shortage of tears, we experience it as dryness and irritation, sometimes accompanied by redness and itching.  Ironically, watery eyes, triggered by an overproduction of the watery part of your tears to protect the eye, can also be a symptom of dry eye.  Finding the best remedy depends on unlocking the reasons and conditions of one’s own dry eye – the underlying causes.   
     
What’s Causing Dry Eye? :
Let’s start with that life nourishing fluid - our tears.  In addition to embarrassing us in sappy movies and connecting us to the well of human empathy, tears also clean and moisturize our eyes while providing them with enzymes that neutralize their indwelling microorganisms.  While generally most dry eye is a factor of either the lacrimal gland under producing tears or the meibomian gland reducing[L1]  oil output ( or clogging)  which then leads to over-evaporation of tears, what loosens or tightens the faucet, so to speak, varies greatly.  It can be a result of menopause,LASIK surgery,  a[L2]  side effect of medications, or a product of living in a dry, dusty, polluted, or windy city, such as Las Vegas or Tucson.  It can be an alarming indicator of Sjogren’s Syndrome lupus[L3] , rheumatoid arthritis, or ocular rosacea if occurring alongside other issues.  As if that wasn’t daunting enough diagnostically, dry eye is also linked to long hours at the computer, extended contact lens wear, smoking, and seasonal allergies.  It could be a combination of things, as well.  If you find yourself in a rare spell of dry eye, some over the counter drops may be just what the doctor ordered; however, if it is a chronic issue, it may require some deeper investigation, or lifestyle changes, such as installing an air filter or taking more breaks from the electronic devices. 

Much Ado about Drops:
“Artificial tears,” which are the most common eye drops, come in two varieties – with and without preservatives.  If you are struggling with a more severe case of dry eye and using them multiple times a day, it is recommended that you use those with fewer additives.  Some artificial tears will also include electrolytes to help balance the tear composition for the surface of the eye, and your ophthalmologist or optometrist may prescribe eye drops which tackle inflammation.  Do be aware, when contemplating your options, that many eye drops that focus their pitch on “reducing redness” are not as helpful in providing moisture.  Though they may be a good solution if you have a big meeting to appear presentable for, your eyes can acquire a tolerance to the eye-whitening vasoconstrictors in these red-eye fixes which can lead to more redness in the long term.  If you wear contact lenses, make sure to remove them before using the eye drops and wait 15-20 minutes before putting them on again.  

In general, eye drops make your eyes drier by washing away the natural lubricants your eyes produce. 

Check with your Ophthalmologist:
If dry eye is a troubling reoccurrence, make the time to discuss possible causes with your eye doctors[L4] .  He or she may recommend nutritional supplements such as omega-3 fatty acids Theralife Eye oral capsules, and more..  The two of you can also plan a long term strategy that identifies and addresses your unique factors. 

Emily Hunter crafts content on behalf of the eyecare specialists at Eyecare 20/20.  In her spare time, she cheers for Spirit of Atlanta, Carolina Crown and Phantom Regiment, creates her own sodas, and crushes tower defense games. Follow her on Twitter at @Emily2Zen