Rosacea and Ocular Rosacea

Rosacea (pronounced Rose-Ay-Shah) is a chronic disease that affects both the skin and the eyelids.

People with rosacea of the skin have redness or acne-like changes in the mid-facial area.  Approximately half of the patients with rosacea will have ocular symptoms, manifesting primarily of both the antierior and posterior blepharitis.  More than half of people with rosacea affecting their skin may have some symptoms of ocular rosacea.  People who have ocular rosacea (involving the eye) may have:

Ocular rosacea, on occasion, may affect eyesight if it is left untreated.  Once ocular rosacea is treated and controlled, a patient’s condition generally improves.

What Causes Rosacea?

Scientists do not know what causes rosacea, but some think that genetics and environment may play a role in its development.  Some researchers believe that rosacea is a disorder that involves swelling of the blood vessels, resulting in flushing and redness.  Other scientists think that a microscopic organism or mite in tiny facial hair follicles may clog the skin’s oil gland openings, causing swelling and redness.  Some research has also shown a possible link between rosacea and the bacteria called Helicobacter pylori – the same bacteria that causes gastrointestinal infections.  Several factors are known to aggravate (but not cause) rosacea, including:

  • Exposure to heat, sunlight, wind, and cold
  • Strenuous physical activity
  • Drinking alcohol
  • Consuming hot drinks or spicy foods
  • Experiencing emotional stress
  • Coughing for long periods

How is Rosacea Treated?

Rosacea cannot be cured, but it can be treated and controlled.  For skin symptoms, doctors usually prescribe either a topical antibiotic (which is applied directly to the skin) or, in more severe cases, an oral antibiotic (taken by mouth).  Doxycycline (or tetracycline) are antibiotics and may be required in patients with rosacea.  Doxycycline possesses both the anti-inflammatory properties as well as antibacterial properties.  This class of antibiotics is specifically absorbed by oil glands.  As such, doxycyline is particularly effective for adolescent acne, acne rosacea, and blepharitis.  Acne rosacea can be treated topically with brimonidine (MIRVASO) or metronidazole (METROGEL).  Unfortunately, these creams should not be used on the eyelids since they can be irritating to the eyes.  Prescription eye drops are used to treat ocular rosacea.  Artificial tear-type saline solutions can help to relieve some of the symptoms of ocular rosacea by keeping eyes well-moisturized.  Some people, however, should avoid using eye drops specifically meant for clearing bloodshot eyes, as these drops can make ocular rosacea symptoms worse.

Baltimore Eye Physicians wants to deliver the highest technologic advances in the management of rosacea.  Patients frequently benefit with intense pulse light therapy (IPL).  The amplified light used in the eyelid-oculofacial area, has been proven to be effective to open blocked meibomian glands to reduce ocular inflammation.  Initially four treatments are recommended, one month apart, and then repeated treatment every six months.  Approximately 90% of patients treated with IPL will demonstrate significant improvement of rosacea symptoms.  Unfortunately, IPL is not covered by insurance.

View our pamphlet for ocular rosacea here