Ocular Rosacea - Symptoms, Causes, Diagnosis & Treatment

6 sources cited
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What is Ocular Rosacea?

Ocular rosacea is a common inflammatory condition of the eyes' surface. It causes redness, watering, and burning, leaving eyes feeling dry and sensitive. It's a disease that often affects people who have rosacea. Rosacea is a chronic skin condition that causes reddening and irritation.1

Approximately 5.5% of the adult population has rosacea.2 It’s most common in females. However, ocular rosacea is less common, affecting less than 1% of people.3

Some people have ocular rosacea without skin problems, while the opposite is true for others. Around 15% of the time, eye symptoms appear before skin symptoms.

Anyone can develop ocular rosacea, but it's most common after age 30 and typically seen between ages 40 and 59.

Currently, there is no cure for ocular rosacea, but medications can help. It’s essential to seek medical attention for ocular rosacea symptoms as it can cause permanent vision loss.4

What are the Symptoms of Ocular Rosacea?

If you have ocular rosacea, you may experience the following symptoms:3

  • Red, bloodshot eyes
  • Watering eyes
  • Dry, burning, or itchy eyes
  • Vision sensitivity
  • Blurred vision
  • Dilated small blood vessels on the white of the eye
  • Swollen eyelids
  • Feeling of grittiness

Ocular rosacea may be associated with other eye conditions:

  • Chalazion or stye
  • Eye infections such as conjunctivitis (pink eye) or blepharitis
  • Corneal ulceration

What Causes (or Triggers) Ocular Rosacea?

The exact cause of ocular or skin rosacea is unknown. However, in almost 6 in 10 cases, ocular rosacea is associated with skin rosacea.2

Other potential causes include:

  • Mites and microorganisms. Demodex mites frequently inhabit eyelash follicles. These tiny mites may trigger inflammation or block the eyelid glands.5
  • Inflammatory markers. An inflammatory protein called interleukin 1-alpha (IL-1α) is increased in tears and can inflame and damage eye tissue.
  • Bacteria. Ocular rosacea may improve with antibiotics indicating that bacteria play a role. Doctors also believe that Helicobacter pylori bacteria, which also causes gastrointestinal infections, may be involved in ocular rosacea.

Certain foods and environmental factors can also trigger a rosacea flare-up and make symptoms worse. These include:

  • Exposure to heat, sun, wind, or cold
  • Taking saunas or hot baths
  • Strenuous activities such as running
  • Drinking alcohol, hot coffee, or tea
  • Eating hot or spicy foods or dairy products
  • Emotions such as stress and feeling sad
  • Some medications, such as cortisone cream

Additionally, some systemic disorders are associated with rosacea. These include high blood pressure and abnormal blood fat levels. 

Risk Factors

Having skin rosacea is one of the main risk factors for ocular rosacea. However, it can occur without skin involvement.

The risk factors for skin rosacea include being female and Caucasian. Researchers believe there is a genetic link. 

In contrast, ocular rosacea affects men and women equally. It's also more common in fair-skinned people of Celtic and Northern European origin.

When to See a Doctor

Anyone experiencing eye problems, or the symptoms of ocular rosacea, should see their primary care provider. They can prescribe medications or refer the person to an ophthalmologist. Early diagnosis and treatment are essential to prevent further damage to the eyes. 

Diagnosis 

Diagnosing ocular rosacea can be challenging as there are no specific tests. Therefore, doctors diagnose the condition based on medical history, symptoms, and a clinical exam. They may take a skin scraping or eyelash sample to confirm the presence of eyelash mites.

Doctors may suspect ocular rosacea if someone has skin rosacea and eye symptoms. However, it can be challenging to diagnose if there are no skin problems as many of the symptoms of ocular rosacea are nonspecific.

Potential Complications

A person can develop an inflamed cornea (keratitis) without proper ocular rosacea treatment. Although rare, ocular rosacea can cause this complication.

With each episode of keratitis, the cornea becomes thinner and more opaque as blood vessels form. Sometimes this can lead to deep ulcers and perforation. It could also lead to vision loss.

Although rare, other complications of ocular rosacea include:

  • Inflammation of the iris (iritis)
  • Inflammation of the clear tissue lining the inner eyelids and sclera (episcleritis)
  • Inflammation of the white of the eye (scleritis)

Treatment for Ocular Rosacea 

Treatment for ocular rosacea may depend on the severity of someone's symptoms. Doctors may recommend eye drops, systemic medications, surgery, and home remedies.

Professional Treatment Options

Doctors may prescribe topical antibiotic or antibiotic eye drops. These may include:

  • Azithromycin
  • Bacitracin
  • Erythromycin
  • Metronidazole

They may also recommend topical medications such as non-steroidal anti-inflammatory agents and steroid eye drops to relieve inflammation. Topical steroids are only suitable for short-term use. In the long-term, they can lead to glaucoma and cataracts. If symptoms don't improve with topical steroids, topical cyclosporine is an alternative.

Systemic medications

Oral antibiotics may help:

  • Reduce the number of bacteria
  • Improve the tear film
  • Reduce inflammation
  • Regulate secretions from the eyes' oil glands (meibomian glands)

Doctors may recommend tetracyclines such as doxycycline or macrolides such as erythromycin. People typically take these antibiotics for up to three months and then taper the dose over a further two months.

Oral antibiotics may also help if the person has a stye that doesn't clear with topical antibiotics.

Other options include oral retinoids like isotretinoin. However, because its side effects include dry eyes and increased infections, it may aggravate ocular rosacea.

Surgery

If someone has corneal complications such as scarring or perforation, surgery may help. A keratoplasty or corneal transplant replaces part or all the cornea with tissue from a donor.

Doctors may also remove styes with surgery if they don't improve with warm compresses and antibiotics.  

Home Remedies

Some home remedies may help relieve the symptoms of ocular rosacea, including:

  • Keeping the eyelids clean. Use a damp cotton bud and diluted baby shampoo or bicarbonate of soda to clean the eyelids and eyelashes gently. This helps remove skin scales and bacteria.
  • Applying a warm compress. Sitting with a warm, damp washcloth or cotton ball on the closed eyelids for five minutes can help with styes and cysts.
  • Using artificial tears. Pharmacies sell artificial tears that can lubricate the eyes and relieve dryness.
  • Avoiding wearing contact lenses. People who wear contact lenses should swap to eyeglasses to prevent irritation of inflamed eyes.
  • Taking omega-3 fatty acid. Research suggests these supplements may help dry eyes.6

Outlook 

Ocular rosacea is a condition with no cure. Although the symptoms can be uncomfortable, medications and home remedies can help control them.

There are some serious complications associated with ocular rosacea. Therefore, anyone experiencing eye or visual symptoms should speak to their doctor or ophthalmologist.

Can You Prevent Ocular Rosacea?

No, you can't prevent ocular rosacea, but you may be able to prevent flare-ups. Some people find that certain beverages, alcohol, sunlight, or other triggers can aggravate symptoms. Therefore, it's a good idea to keep a symptom diary to identify potential triggers and avoid them.

Additionally, doctors may recommend that people with skin rosacea undergo periodic eye exams to assess their visual health. By doing so, any problems can be caught early on and treated.

Summary

Ocular rosacea is an inflammatory eye condition. It causes redness, swollen eyelids, and blurred vision, among other symptoms. The condition often develops in people with skin rosacea, but not always.

The cause of ocular rosacea is unknown, but genetics, bacteria, and other health conditions may contribute.

There is no cure for ocular rosacea, but various treatments can help ease symptoms. These include good eyelid hygiene, eye drops, and oral medications.

If you're experiencing symptoms of ocular rosacea, speak with a doctor. Prompt and proper treatment reduces the risk of complications.

6 Cited Research Articles
  1. Jabbehdari, S., et al. “Update on the pathogenesis and management of ocular rosacea: an interdisciplinary review.” European Journal of Ophthalmology. 2020.
  2. Tavassoli, S., et al. “Ocular manifestations of rosacea: A clinical review.” Clinical and Experimental Ophthalmology.” 2021.
  3. Boyd, K. “Ocular rosacea.” American Academy of Ophthalmology. 2022.
  4. Redd, T., et al. “Ocular rosacea.” Current Opinion in Ophthalmology. 2020.
  5. Wong, D. “Ocular rosacea. “ DermNet NZ. 2014.
  6. Bhargava, R., et al. “A randomized controlled trial of omega 3 fatty acids in rosacea patients with dry eye symptoms.” Current eye research. 2016.
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