Ocular Rosacea

Rosacea is a skin condition that affects more than 16 million people in the United States. Typically rosacea is characterized by facial redness, flushing, papule, acne lesions, telangiectasias and broken blood vessels on the face. However, many patients suffer from ocular rosacea with dry eyes and blepharitis. While the most common form of rosacea affects the skin on the cheeks, nose, forehead, chin, and chest, ocular rosacea is a significant, treatable condition. Ocular rosacea, also known as subtype IV rosacea, can occur alongside skin rosacea or can occur on its own without any evidence of skin rosacea. The symptoms of ocular rosacea can vary, but often causes redness, swelling, and discomfort in the form of dry eyes, cysts, or inflammation and infection. While there is no cure for ocular rosacea, it can be managed successfully with the proper treatment. If the symptoms are left untreated, severe ocular rosacea can develop, which can lead to blurred vision and even loss of sight. For that reason, it is imperative to seek treatment from an ophthalmologist or board-certified dermatologist, such as Dr. Michele Green in NYC.

Without a permanent cure for ocular rosacea, treatment takes the form of symptom management, which can be done in a number of ways. Prescription medications can be used to fight infection, including or oral antibiotics, such as azithromycin and doxycycline. Topical antibiotics and eye washes can be utilized to decrease inflammation and the risk of infection. Eye drops, either in the form of prescription steroid drops or over-the-counter artificial tears can help combat dryness, and regulating the tear film. There are also home remedies, such as eyelid scrubs and warm compresses, which are good habits to successfully manage ocular rosacea long term. With many treatment options to choose from all for different symptoms, it is important to consult an expert, such as Dr. Green, to develop a treatment strategy that is most effective for your specific needs, such as Dr. Green.

Dr. Michele Green is an internationally renowned, board-certified dermatologist, who has been treating patients in her Upper East Side New York City for over 25 years. Dr. Green is an expert in treating acne, rosacea, acne scars, and the vascular component of rosacea with lasers. She has been consistently voted as one of the best dermatologists in New York by New York Magazine, Castle Connolly, the New York Times, and Super Doctors. If you are suffering from the dermatological manifestations of rosacea or ocular rosacea, Dr. Green is here to help.

What is rosacea?

Rosacea is a common skin condition that affects 16 million people in the United States. Characterized by bumps that resemble acne, papules, pustules, flushing, telangiectasias, broken blood vessels, vascular dysregulation leading to redness. Rosacea is most commonly located on the nose, cheeks, forehead, chin, and chest. In addition to the visual symptoms of the condition, patients may experience burning and itching sensations as a result of rosacea. In the early stages, the skin of patients with rosacea may appear “ruddy” with redness or a pink color in the nose and cheeks. As the condition progresses, the texture of the skin can change to include bumps and lesions and vessels in the skin can develop telangiectasia. In very severe instances of rosacea, the condition can develop into rhinophyma, which is characterized by a thickening of the skin along the connective tissues of the nose. Rhinophyma is a serious condition that can result in an alteration in the structure and look of the face.

What is ocular rosacea?

Ocular rosacea, also known as rosacea of the eye or subtype rosacea IV, is a form of rosacea that affects the eyes. Most commonly affecting patients in the 50 to 60 age group, symptoms of ocular rosacea may occur after the onset of skin rosacea, at the same time as symptoms of skin rosacea, or can arise independently of the skin condition. While the dermatologic manifestations of rosacea more commonly affect women than men, ocular rosacea develops equally in men and women. Research has shown that ocular rosacea is fairly common to develop in patients who have previously developed rosacea. One study published in the Journal of the American Academy of Dermatology suggests that between 58% and 72% of patients with rosacea will develop symptoms of ocular rosacea during their lifetime. Patients who experience ocular rosacea may experience photophobia, which is an increased light sensitivity, infection, blurred vision or visual impairments. Severe cases of ocular rosacea can lead to inflammation and infection of the cornea, which can result in corneal ulcerations, perforation of the eyes, and potential blindness.

18-24 year old, VBeam for Rosacea

What are the symptoms of ocular rosacea?

Symptoms of ocular rosacea are distinct from the symptoms of skin rosacea. Ocular manifestations of rosacea can include such symptoms as:

• Swelling or redness on the eyelids or lid margin, which is the location on the eye where the eyelashes and meibomian glands are found
• Bloodshot eyes
• Meibomian gland dysfunction, which is when the oily glands on the eyelids get clogged
• Dry eye
• Conjunctivitis, more commonly known as pink eye
• An excess of moisture in the eyes (teary eyes)
• Chalazion or stye, which is an inflamed growth in the eye
• Blurred vision
• Blepharitis, an eye disease in which inflammation leads to swollen eyelids and crust along the eye lashes. The increased production of bacteria in this area then leads to a creation of biofilm, a toxic environment on the eye

If rosacea patients experience any of the symptoms above, it is important to consult an ophthalmologist and receive an eye exam. Left unresolved, these eye symptoms can lead to further complications that may result in lost vision.

What causes ocular rosacea?

The causes of rosacea and ocular rosacea are still unknown. While research has been done on the subject, results have been inconclusive. There are, however, several hypotheses on suspected causes of ocular rosacea. Some research postulates that ocular rosacea is a genetic condition while others believe that it arises as a result of environmental factors. Some experts believe that organisms such as demodex mites, which are found in the hair glands, can clog the meibomian glands and cause inflammation and redness. Still others think that the condition is due to blood vessels swelling, which leads to swelling and redness in the skin. Without understanding the exact cause of the condition, it is difficult to determine the best means of prevention. However, ophthalmologists and dermatologists recommend healthy eye care in the form of maintaining good eye lid hygiene and avoiding certain environmental triggers.

What are the risk factors for developing ocular rosacea?

While the exact cause of ocular rosacea and skin rosacea is unknown, there are certain environmental factors and lifestyle choices that can contribute to the rise and flare-up of rosacea, including:

• Exposure to the sun, heat, wind, or cold outside
• Consuming alcoholic beverages
• Excessive caffeine consumption
• Eating spicy foods
• High activity, including running or very active sports
• Eating inflammatory foods such as chocolate and cheese
• Spending time in a sauna or hot bath
• Some medications, including cortisone creams or blood vessel dilation drugs
• Experiencing certain emotions such as stress, anxiety, or anger

What does ocular rosacea look like?

Many patients ask, what does ocular rosacea feel like and look like? Ocular rosacea can manifest in many ways and rosacea patients may not experience all of the same symptoms. For some patients, cutaneous rosacea can look like conjunctival inflammation or bloodshot eyes. For others, they may experience the development of a crust on the eyelashes or a foreign body sensation, which may be the effect of a cyst. In severe cases, keratitis can occur, which is an inflamed cornea. Inflammation or damage to the cornea can lead to vision problems, including blurred vision or loss of vision. When experiencing any symptoms of cutaneous rosacea, it is important to visit a dermatologist or ophthalmologist for an eye exam to treat the symptoms in order to avoid the severe manifestations and possible damage of the disease.

How to cure eye rosacea

Unfortunately, there is no cure for ocular rosacea. While there is a large amount of research that is being done on the condition, researchers have not yet determined a treatment that can completely cure eye rosacea. Without a cure, it is imperative to treat the symptoms of the condition in order to alleviate the discomfort caused rosacea and to inhibit the potential for greater damage to the cornea. If you are experiencing any of the symptoms of ocular rosacea or skin rosacea, it is important to consult with a board-certified dermatologist, such as Dr. Michele Green in New York City, to start a treatment plan for your symptoms.

VBeam – 2 months before and after

How to treat ocular rosacea

While there is no cure for ocular rosacea, the symptoms can be treated in order to reduce the pain and discomfort associated with the condition. Ocular rosacea treatment options include prescription medication, minor eye procedures, home remedies, and natural eye care to alleviate the symptoms.

Topical or Oral Antibiotics – When addressing inflammation due to bacterial infection in the eye, a health care provider may prescribe topical or oral antibiotics to address the infection. Most commonly, tetracyclines are prescribed to treat rosacea, due to their ability to decrease the natural oil viscosity, which can help to reduce the meibomian gland dysfunction that can occur as a result of rosacea. Doxycycline, a type of tetracycline and an oral antibiotic, is often prescribed for ocular rosacea and can be taken long term once or twice daily. Alternatively, topical antibiotics such as azithromycin and erythromycin have also been shown to reduce the symptoms of ocular rosacea over a period of approximately three months.

Steroid Eye Drops – Steroid eye drops or steroid ointments are meant for short term use and can help decrease inflammation associated with ocular rosacea. The eye drops act as an anti-inflammatory agent after only a couple of days.

Artificial Tears – In order to combat the dryness that can be associated with ocular rosacea, an ophthalmology expert may suggest the use of artificial tear eye drops. These non-preserved artificial tears can help to lubricate the eye and revitalize the tear film on the eye to prevent damage to the cornea. It is important to note that patients should not use eye drops that are meant to treat blood shot eyes, as these eye drops can make the symptoms of rosacea worse.

Eyelid scrubs – To reduce the symptoms of rosacea, it is also important to practice lid hygiene and good eye care. To do so, Dr. Green recommends a daily eyelid scrub to clean your eyes and reduce the risk of infection. To do so, choose a gentle cleanser, such as baby shampoo, and apply to a warm washcloth. Gently scrub the closed eyelid to reduce the buildup of the toxic environment known as biofilm, where bacteria can multiply.

Warm Compress – In addition to an eyelid scrub, a warm compress is a simple lid hygiene practice that can assist in unclogging the glands and improving tear film. Clogged glands can be a cause of inflammation and employing the use of a warm compress several times a day can help to clear the glands. To use a warm compress, gently press on the closed eyelids with a warm washcloth, massaging the eyelids. Warm compresses are best employed as long-term eye care, which will show effective results over time.

Punctal Plugs – If other treatments for dry eye are insufficient, Dr. Green may recommend the use of punctal plugs, which are small devices placed in the tear ducts to reduce dryness and stabilize the tear film. Continuous dry eye can lead to damage to the cornea and so if artificial tears are insufficient to increase moisture to the eye, either semi-permanent or dissolvable punctal plugs can be used.

Topical Metronidazole – For its anti-inflammatory effects, your healthcare provider may prescribe a topical metronidazole, which is an anti-parasitic agent. The medication has been demonstrated to be effective in reducing the symptoms of rosacea, however, the treatment can’t be placed directly onto the eyelids.

25-34 year old male treated with VBeam

What is the best treatment for ocular rosacea?

When patients ask, what is the best treatment for ocular rosacea, the answer is: it depends. The treatment options for ocular rosacea cannot cure the disorder itself but rather treat the symptoms. For that reason, it is important to determine the most apparent symptoms in order to determine the treatment option that is best for you. An ophthalmologist or board-certified dermatologist, such as Dr. Michele Green, can examine your condition and will discuss your individualized needs to make a determination about what treatment, or series of treatments, to prescribe.

How to treat ocular rosacea naturally

For patients who are not interested in receiving any oral or topical medications, there are options to treat rosacea naturally. At home remedies for ocular rosacea include the use of warm compresses and eyelid scrubs. For a warm compress, patients can use a warm washcloth to gently massage the eyelid. This can help to unclog the glands in the eyelid, which may be responsible for inflammation in the eye. Additionally, patients can practice lid hygiene with an eyelid scrub. To perform and eyelid scrub, take a warm washcloth with baby shampoo and gently wash the eyelid. This can help to reduce the build up of biofilm, where bacteria can grow to cause an eye infection. While effective, these at home remedies typically do not provide immediate results. These habits can help to reduce the symptoms of ocular rosacea over time.

What does ocular rosacea feel like?

In addition to the visual symptoms of ocular rosacea including redness, bloodshot eyes, and swelling, there can be many physical discomforts associated with the condition as well. Dry eyes can lead to an itching and burning sensation and, alternatively, increased teary eyes can lead to too much moisture in the eyes and blurred vision. For some patients, a flare-up can be further exacerbated if you use contact lenses. For that reason, Dr. Green recommends avoiding contact lens use while symptoms persist. Ocular rosacea can also lead to increased light sensitivity, blurred vision, or loss of vision should damage occur to the cornea.

Can ocular rosacea cause blurred vision or blindness?

Yes. When the symptoms of ocular rosacea are left unchecked, severe ocular rosacea can lead to blurred vision or a loss of vision. Inflammation in the eye can lead to a corneal ulcer, which, when untreated, can cause damage to the cornea. This damage is serious and may be blinding. For that reason, it is imperative to consult with an ophthalmologist or board-certified dermatologist, such as Dr. Green, when you notice symptoms of skin or ocular rosacea. Your health care provider can determine a treatment plan to limit the potential of developing severe cutaneous rosacea.

Can you have rosacea without redness?

Redness is one of the potential symptoms of rosacea, but ocular rosacea can take other forms that may not include redness as a symptom. For example, symptoms of ocular rosacea without redness can include chalazion, dry eye, crust on the eyelashes or lids, blurred vision, or teary eyes. If you have any of these symptoms, it is best to consult your health care provider to determine if you may have ocular rosacea.

Is ocular rosacea an autoimmune disease?

The cause of ocular rosacea is, as of yet, unknown to researchers. Some studies have demonstrated a link between the development of ocular rosacea and existing autoimmune diseases however, the link has not yet been determined to be causation.

Can you develop rosacea around your eyes?

Skin rosacea commonly occurs on the nose, cheeks, forehead, chin, and chest but can also affect the eyes. Ocular rosacea is characterized by redness, swelling, and crust around the eyes or dryness, wetness, or styes in the eyes. Studies have shown that 58-72% of patients with skin rosacea will also have symptoms in or around the eye area.

Why does rosacea affect the eyes?

Researchers have been unable to determine the root cause of ocular rosacea. Patients with ocular rosacea may have symptoms due to genetics or environmental causes. If you are suffering from ocular rosacea, it is important to have your symptoms treated in order to avoid the development of severe cutaneous rosacea.

How do I get started with the treatment of my ocular rosacea today?

If you are suffering from facial rosacea or ocular rosacea, Dr. Michele Green is here to help. Dr. Green is an internationally renowned expert in treating acne, rosacea, and acne scars. With the latest cutting edge treatments, from the VBeam laser, IPL, Blu light, Fraxel, eMatrix, HydraFacials, chemical peels, and other modalities, Dr. Green will help rejuvenate your skin and give you a clear, beautiful, complexion. To schedule a consultation for rosacea treatment today, please contact us online or call Dr. Michele Green’s NYC based office at 212-535-3088.