How to manage and treat Ocular Rosacea

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. 

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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