Ocular Rosacea
Rosacea is a common skin condition that causes redness, flushing, bumps and pimples, and visible blood vessels. Did you know rosacea can also affect the eyes? Rosacea affecting the eyes is called Ocular Rosacea, and it is one of the subtypes of rosacea recommended by the National Rosacea Society.
According to the originally published classification of rosacea by Wilkin and colleagues, there are four subtypes of rosacea described in the table below. J Am Acad Dermatol. 2002 Apr;46(4):584-7
Patients with subtype 4, ocular rosacea often describe a gritty feeling, burning and stinging, dryness, itching, and blurred vision. Eye doctors and skin doctors often suspect ocular rosacea when they see skin signs of rosacea as well. However, ocular rosacea can occur independently of obvious skin signs of rosacea in up to 20% of patients. The severity of ocular rosacea is independent of the severity of the skin rosacea.
A number of issues have been shown to play a role in ocular rosacea including meibomian gland dysfunction, bacteria, and demodex mites.
Therapy for ocular rosacea is usually initiated by optometrists and ophthalmologists. However, we often see patients for rosacea in the dermatologist’s office as well.
Medical therapy includes:
-Effective gentle cleansing of eyelids and good eyelid hygiene.
-Moisturizing drops may be of some very limited help. Avoid drops for red eyes.
-Omega-3 fatty acid supplementation.
-Oral antibiotics. This is where we most often come in as dermatologists. Usually what happens is we start treating the skin rosacea with oral antibiotics – doxycycline and minocycline. The patient comes back in 6 weeks saying, “My skin is better, but my eyes feel miraculously better.” Despite our patient literature discussing ocular rosacea, most patients still don’t realize how much their eyes are being affected until they are effectively treated. If oral antibiotics are going to help a patient, we usually see a dramatic improvement within 6-12 weeks. Antibiotics sometimes need to be maintained long term but often can be tapered to a low dose.
-Topical ivermectin. There are some new small studies that show that treating demodex with topical ivermectin may help with ocular rosacea. I have had anecdotal reports from patients of this helping as well.
Procedural therapy includes:
-Lipiflow. Lipiflow is a procedure that uses heat and suction to help the Meibomian gland dysfunction offered by eye doctors.
-Intense Pulsed Light. I have been intrigued by this option because patients are asking about it almost daily. This is mainly because local eye doctors are advertising this as an option for rosacea patients. We have been doing IPL for skin rosacea since 2005, so my next article will be an in-depth look at IPL for Ocular rosacea. Stay tuned!
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