Ocular Rosacea

Rosacea is a common skin condition that affects more than 16 million people in the United States. Typically, rosacea is characterized by facial redness, flushing, papules, 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 patients often experience 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.

Since ocular rosacea is chronic, treatment of this condition involves symptom management, which can be done in several ways. Prescription medications, including topical and oral antibiotics such as azithromycin and doxycycline, can be used to minimize inflammation and treat infections. Various eye drops and artificial tears can also be used to decrease inflammation and redness and regulate the tear film. There are also home remedies, such as eyelid scrubs and warm compresses, which are good habits for maintaining proper eye hygiene and managing ocular rosacea in the long term. With many treatment options to choose from 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, an internationally renowned board-certified dermatologist in New York City, has over two and a half decades of experience providing her patients worldwide with the best noninvasive treatment options available, including for ocular rosacea. 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. She has helped countless individuals achieve their ideal aesthetic goals with a combination of specially formulated skincare products from her MGSKINLABs skincare line and non-invasive cosmetic treatment options. When you consult with Dr. Green at her private dermatology office in the Upper East Side neighborhood of Manhattan, she will work with you to create a customized treatment plan for managing your ocular rosacea that includes a combination of specially formulated skincare products and any necessary prescriptions for achieving and maintaining healthy, clear skin and eyes that lasts.

What is rosacea?

Rosacea is a common inflammatory skin condition that affects millions of people around the world—characterized by bumps that resemble acne, papules, pustules, flushing, telangiectasias, broken blood vessels, and vascular dysregulation leading to redness. Rosacea is often located on the nose, cheeks, forehead, chin, and chest. In addition to these symptoms, patients with rosacea may also experience burning and itching sensations. In the early stages, the skin of patients with rosacea may appear “ruddy” with red or pink color in the nose and cheeks. As the condition progresses, the texture of the skin can change to include bumps, lesions, and vessels in the skin that can develop into telangiectasia, also known as broken blood vessels. 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.

How to Best Treat the Facial Redness of Rosacea?

The most common presentation of rosacea is facial redness from flushing, telangiectasias, broken blood vessels, and vascular dysregulation. While facial redness is not dangerous, many patients want to treat the redness for cosmetic purposes. Within Dr. Michele Green’s boutique dermatology office are a variety of treatments for facial redness, including the VBeam laser, which is the gold standard for treating facial redness. The Vbeam laser is a pulsed dye laser that targets the red pigmentation within the skin by operating at a 595 nm wavelength. The surrounding tissue is left unharmed, and to minimize any discomfort, the VBeam is equipped with a Dynamic Cooling Device that emits a burst of cool air before each pulse of the laser. Pulsed dye laser therapy can target various forms of facial redness, including visible blood vessels, post-inflammatory hyperpigmentation, spider veins, broken capillaries, red acne scars, red stretch marks, and any other vascular lesion. The Vbeam laser has also been shown to stimulate new collagen production in the skin, which can improve skin tone and texture. Often, four to six VBeam treatment sessions spaced four to six weeks apart are necessary to achieve optimal results. There is no pain or downtime involved with the VBeam laser, meaning patients can easily receive the treatment and then return to their daily activities immediately after the treatment session.

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 and eyelids. Ocular rosacea is a chronic condition that requires lifelong management once symptoms develop. Most commonly affecting patients aged 50-60, 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 a common condition to develop in patients who have previously been diagnosed with facial 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. Ocular rosacea often presents with dry eyes, inflammation in and around the eyes, styes along the edge of the eyelid, or a gritty feeling. 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 style, which is an inflamed growth in the eye
• Blurred vision
• Blepharitis is an eye disease in which inflammation leads to swollen eyelids and crust along the eyelashes. The increased production of bacteria in this area creates biofilm, a toxic environment on the eye.

If rosacea patients experience any of the above symptoms, they should consult an ophthalmologist and receive an eye exam. Left unresolved, these eye symptoms can lead to further complications, including lost vision.

What is the main cause of ocular rosacea?

The causes of rosacea and ocular rosacea are still unknown. While research has been done on the subject, results have yet to be conclusive. 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 in and around the eyes. Still, others think that the condition is due to swelling in blood vessels, which leads to swelling and redness in the skin. Understanding the exact cause of the condition is necessary to determine the best means of prevention. However, ophthalmologists and dermatologists recommend maintaining good eyelid hygiene and avoiding certain environmental triggers to prevent flares of ocular rosacea.

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 flare-ups of rosacea, including:

• Exposure to the sun, heat, wind, or cold outside
• Consuming alcoholic beverages
• Excessive caffeine consumption
• Eating spicy foods
• Strenuous activity, including running or 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 patients may not experience all of the same symptoms. For some patients, ocular 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 ocular 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 do you treat rosacea in the eyes?

Unfortunately, there is no cure for ocular rosacea. While a large amount of research is being done on the condition, researchers have not yet determined a treatment that can completely cure it. Without a cure, it is imperative to treat the symptoms of the condition to alleviate the discomfort caused by rosacea and to inhibit the potential for greater damage to the cornea. Suppose you are experiencing any of the symptoms of ocular rosacea or skin rosacea. In that case, 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. Treatment plans can include home remedies such as warm compresses or prescription medications such as eye drops or oral antibiotics.

VBeam – 2 months before and after

How to treat ocular rosacea

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

Topical or Oral Antibiotics – Topical and oral antibiotics are often used to treat rosacea symptoms due to their anti-inflammatory properties. Tetracyclines, which include doxycycline, are often used to treat rosacea and other inflammatory conditions due to their anti-inflammatory properties and ability to decrease oil viscosity. Ocular rosacea can cause meibomian gland dysfunction, which can increase the viscosity of natural oils around the eyes. The most common oral antibiotic prescribed for ocular rosacea is doxycycline, which can be taken 1-2 times daily long-term. Alternatively, topical antibiotics such as azithromycin and erythromycin have also been shown to reduce the symptoms of ocular rosacea over approximately three months.

Steroid Eye Drops—Steroid eye drops or ointments are short-term treatment options for ocular rosacea. They decrease inflammation in and around the eyes. After a couple of days of using these anti-inflammatory topicals, the symptoms of ocular rosacea decrease.

Artificial Tears—Dry eyes are a common symptom of ocular rosacea. To combat this, a healthcare provider may suggest the use of artificial tear drops. Non-preserved artificial tears can help lubricate the eye and revitalize the tear film to prevent damage to the cornea. However, patients should only use eye drops as directed by their healthcare provider to prevent adverse effects.

Eyelid scrubs—Good eye hygiene and care are important to reduce the symptoms of rosacea. Dr. Green often recommends that her patients with ocular rosacea use a daily eyelid scrub to clean the eyes and reduce the risk of rosacea flare-ups or infections. To perform the eyelid scrubs, choose a gentle cleanser, such as baby shampoo, and apply it 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 practice that can assist in unclogging the glands and improving tear film. Clogged glands can cause inflammation, and employing a warm compress several times a day can help to release the debris clogging the glands, clearing them. To use a warm compress, gently press on the closed eyelids with a warm washcloth, massaging the eyelids in a slow circular motion. Warm compresses are best employed as long-term eye care, which will show effective results over time.

Punctal Plugs— One of the most common symptoms of ocular rosacea is dry eyes. If other treatments for dry eyes are insufficient, punctal plugs, which are small devices placed in the tear ducts to reduce dryness and stabilize the tear film, may be recommended. Continuous dry eye can lead to damage to the cornea, so if artificial tears, either semi-permanent or dissolvable, are insufficient to increase moisture in the eye, punctal plugs can be placed by an ophthalmologist.

Topical Metronidazole—This antiparasitic medication also has strong anti-inflammatory properties, which have been shown to reduce rosacea symptoms. Dr. Michele Green may prescribe metronidazole cream for patients with blepharitis and other symptoms affecting 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 that it depends. Ocular rosacea is a chronic condition that cannot be cured, but treatments can effectively manage symptoms. The best treatment option depends on the unique combination of symptoms each patient presents with, which is why it is imperative to consult with a board-certified ophthalmologist or dermatologist, such as Dr. Michele Green, who can evaluate your symptoms and create an individualized treatment plan. When you consult with Dr. Green, she will physically examine your eyes and the skin around them before determining which 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 manage ocular rosacea symptoms at home. At-home remedies for ocular rosacea include the use of warm compresses and eyelid scrubs. For a warm compress, patients can use warm water to heat a washcloth, apply the washcloth to the eyelids, and massage gently. This helps to release debris that can clog the pores, minimizing some symptoms and inflammation associated with ocular rosacea. Additionally, patients can practice lid hygiene with an eyelid scrub. To perform an 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.

Does ocular rosacea cause dry eyes?

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. Patients with ocular rosacea often experience dry eyes, which can lead to itching and burning sensation. Often, patients with ocular rosacea have clogged glands of the eyelids, which prevents the necessary fluids and oils from reaching the eyes, leading to dry eyes. Alternatively, increased teary eyes can lead to too much moisture in the eyes and blurred vision. For some patients, a flare-up of dry eyes can be further exacerbated if you use contact lenses. For that reason, Dr. Green recommends avoiding contact lens use while symptoms are flared up. Ocular rosacea can also lead to increased light sensitivity, blurred vision, or loss of vision should damage occur to the cornea.

Does ocular rosacea affect vision?

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

Can you have ocular rosacea without skin rosacea?

While it is less common, it is possible only to have ocular rosacea and no form of skin rosacea. Up to 20% of patients with ocular rosacea never experience dermatological symptoms of rosacea elsewhere on their face or body. These patients typically have the following symptoms: chalazions, dry eyes, crust on the eyelashes or lids, blurred vision, or teary eyes. If you have any of these symptoms, it is best to consult your healthcare provider to determine if you may have ocular rosacea.

Is ocular rosacea an autoimmune disease?

Researchers are still unsure of the cause of ocular rosacea and cannot definitively say if it is an autoimmune disease or not. 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 causal. Like many autoimmune diseases, rosacea is an inflammatory condition that sometimes flares up for no apparent reason. Ultimately, more research must be conducted to determine if ocular rosacea is an autoimmune disease.

Can you develop rosacea around your eyes?

Yes, rosacea can develop around the eyes. Skin rosacea commonly occurs on the nose, cheeks, forehead, chin, and chest, but ocular rosacea can also affect the eyelids and 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. Some patients have dermatologic symptoms of rosacea, such as redness and flushing, and then, over time, develop ocular rosacea with symptoms affecting their eyes and eyelids. Suppose patients believe they are developing rosacea in and around their eyes. In that case, it is vital to consult with a board-certified ophthalmologist or dermatologist, such as Dr. Michele Green, to determine a safe and effective treatment plan.

What triggers ocular rosacea?

While researchers have been unable to determine the root cause of ocular rosacea, they have identified things that can trigger flare-ups. Patients with ocular rosacea may notice their condition worsens after drinking alcohol or caffeinated beverages, eating spicy or inflammatory foods, experiencing extreme temperatures, and more. The triggers for ocular rosacea are different for everyone, so it is important to keep track of what activities worsen your rosacea to prevent recurrent flare-ups.

Who treats ocular rosacea?

Physicians are specifically trained to treat ocular rosacea. Dermatologists, ophthalmologists, and optometrists can all diagnose and treat it. Any patients who believe they may have ocular rosacea should consult with a board-certified ophthalmologist or dermatologist, such as Dr. Michele Green in NYC, to determine if they have ocular rosacea and to develop an effective treatment plan.

How do you calm an ocular rosacea flare-up?

A variety of treatments, including warm compresses, artificial tears, and prescription medications, can calm an ocular rosacea flare-up. Warm compresses can help decrease inflammation by loosening the contents of the oil glands so they can drain. To perform a warm compress, soak a clean washcloth in warm water and then apply it to the eyes for five to ten minutes. Warm compresses are effective at calming down stys and clogged glands. When patients experience dry eyes during a rosacea flare-up, artificial tears can effectively moisturize and lubricate the eyes to relieve them. A variety of artificial tears exist, so it is important to consult with your healthcare provider to ensure you are using the right type of tears for your eyes. In addition to artificial tears and warm compresses, prescription medications can be used to calm down an ocular rosacea flare-up. Medications such as topical azithromycin or oral doxycycline can calm down inflammation and relieve an ocular rosacea flare. These medications can only be prescribed by healthcare professionals, so it is important to consult with a board-certified doctor, such as Dr. Michele Green, who can provide the right prescription to calm down your ocular rosacea flare.

What can be mistaken for ocular rosacea?

Multiple skin and eye conditions present similarly to ocular rosacea, so to receive an accurate diagnosis, it is important to consult with an experienced board-certified dermatologist or ophthalmologist. Conditions that often present similarly to ocular rosacea include blepharitis, dry eye, stye, or dermatitis. Blepharitis is inflammation of the eyelids and often occurs when the oil glands along the base of the eyelashes become clogged and inflamed. Dry eyes are a very common condition in which the eyes either do not create enough tears, or the tears are unable to keep the eyes moisturized. Patients with dry eyes often report redness, irritation, blurred vision, burning/stinging sensation, and tired eyes. Styes, also called chalazia and hordeolum, are painful, inflamed oil glands or hair follicles that often develop when bacteria and debris become trapped in the gland. Dermatitis is the medical term for inflamed skin. One of the most common locations of dermatitis is the eyelids. Eyelid dermatitis often appears red, dry, and flakey. Dermatitis can be caused by contact with an allergen or due to eczema.

What are the best eye drops for ocular rosacea?

Because everyone experiences ocular rosacea differently, there is not one type of eye drop that is the best. Treatment of ocular rosacea can include the following types of eye drops: steroid drops, azithromycin, erythromycin, clarithromycin, and artificial tears. Steroid eye drops are often used to decrease inflammation, redness, and swelling from a multitude of conditions, including rosacea and allergies. Antibiotic eye drops, including azithromycin, erythromycin, and clarithromycin, have anti-inflammatory properties to treat chalazions. These eye drops have also been found to improve the viscosity of oil produced by the meibomian glands along the eyelid. Artificial tears can help when dryness causes itchy eyes and redness. To determine which eye drop is the best for your ocular rosacea symptoms, you should consult with a board-certified ophthalmologist or dermatologist, like Dr. Green, who will evaluate your symptoms and determine which eye drop is best suited to your needs.

How long to take doxycycline for ocular rosacea?

Doxycycline is an oral antibiotic with anti-inflammatory properties that can be prescribed for ocular rosacea. Ocular rosacea typically has associated inflammation, which doxycycline can minimize to manage the condition and prevent flare-ups. Generally, doxycycline is taken once or twice daily for 6-12 weeks. As a prescription medication, it is important to follow the instructions of the prescribing doctor for the safest and most effective treatment.

Is ocular rosacea contagious?

No, ocular rosacea is not contagious. While researchers are exploring the correlation between Helicobacter pylori bacteria and the skin condition, they have yet to find any clear evidence linking the bacteria to the skin condition. Ocular rosacea is not an infection or overgrowth of microorganisms, so it is not contagious. The skin and eye condition occurs due to the body’s reaction to different rosacea triggers, such as alcohol or spicy food.

How to diagnose ocular rosacea?

A healthcare provider such as a dermatologist or ophthalmologist can diagnose ocular rosacea. When you consult with Dr. Michele Green in her private dermatology office, she will physically evaluate the eyes and eyelids, collect your complete medical history, and review the symptoms you have. With this information, she will create a treatment plan based on the correct diagnosis to provide you with clear, healthy skin and eyes.

How long does ocular rosacea last?

Unfortunately, ocular rosacea is a chronic condition that can require lifelong management. Many patients have intermittent flare-ups that often only last for one week but can last up to a few months. While ocular rosacea can flare up due to a number of triggers, there are ways to minimize the amount and duration of flare-ups. By identifying and avoiding triggering activities such as drinking alcohol or eating spicy foods, patients can decrease the likelihood of a bad flare popping up. Another way to minimize flares is by using medications that target the inflammation, calming down the inflammatory process. Patients can be prescribed medications such as topical metronidazole or oral doxycycline to shorten a flare.

How common is ocular rosacea?

Ocular rosacea is a common medical condition. The American Acne and Rosacea Society estimates up to 16 million people in the United States have been diagnosed with ocular rosacea. It is estimated that up to fifty percent of patients who have ocular rosacea also suffer from the same skin condition, making it a common variation of rosacea.

Does ocular rosacea go away?

Unfortunately, ocular rosacea does not resolve on its own. Patients who develop it will require intervention to manage and minimize its effects. If symptoms start, it is imperative to consult with a board-certified ophthalmologist or dermatologist, such as Dr. Michele Green in New York City. If ocular rosacea is left untreated, the inflammation can damage the retina, potentially causing vision changes.

Can ocular rosacea cause blindness?

Yes, if ocular rosacea becomes more severe, it is more likely to negatively affect vision by affecting the cornea. Patients with ocular rosacea can experience blurry vision, and in extreme cases, ocular rosacea can lead to blindness. Some of the symptoms of ocular rosacea are dry eyes and inflammation. When these occur, friction between the eye and eyelid can scratch the cornea. Over time, the scratches on the cornea can develop into scarring, which can be blinding. For your eye health, it is imperative to consult with an expert board-certified dermatologist or ophthalmologist to prevent ocular rosacea from worsening.

Can ocular rosacea cause headaches?

While there is no evidence that ocular rosacea causes headaches, current research indicates an association between the inflammatory condition and migraine headaches. Rosacea is an inflammatory skin disease, and migraines often have related nerve inflammation, leading to symptoms of pain and throbbing headaches. While both conditions have associated inflammation, there is no clear link between the inflammation of ocular rosacea and headaches.

How do I get started with ocular rosacea treatment today?

If you are suffering from facial or ocular rosacea, the first step to treating it is to consult with an experienced, board-certified dermatologist. Dr. Green is an internationally renowned, board-certified dermatologist with over two and a half decades of experience providing some of the world’s most discerning men and women with the best non-invasive treatment options available, including for facial redness and rosacea. When you consult with Dr. Green at her private dermatology office in the Upper East Side neighborhood of Manhattan, she will work with you to create a personalized treatment plan, including a combination of peels, laser therapy, medical-grade facials, topical and oral treatments, and skincare products, for managing your symptoms of rosacea. Castle Connolly, Super Doctors, and New York Magazine consistently identify Dr. Green as one of NYC’s best dermatologists for her holistic approach to treatment and less is more philosophy. Her dedication to her patients and expertise are well-reflected through patient testimonials. She has helped countless individuals achieve their ideal aesthetic goals with a combination of specially formulated skincare products and non-invasive cosmetic treatment options. To schedule a consultation with Dr. Green at her private dermatology office in the Upper East Side neighborhood of Manhattan and develop a customized treatment plan for managing your rosacea symptoms, contact us online or call 212-535-3088 today.