What is Ocular Rosacea?

Ocular rosacea is an inflammatory eye condition that often occurs in conjunction with facial rosacea, which is characterized by a bumpy, red rash. Ocular rosacea typically causes chronic dryness, burning, redness, and irritation in the eyes as well as inflammation and swelling of the eyelids. Common complaints include the sensation of “something in the eye” and sensitivity to light, and the eyes often will appear bloodshot as well. A person may also develop conjunctivitis, or in the most severe cases, corneal infections and keratitis, which can lead to blindness. Based on severity, treatment ranges from warm compresses and over-the-counter eyedrops to antibiotics and even surgical intervention. At least 50 percent and as many as 80 percent of people with facial rosacea also experience ocular symptoms, and treatment of facial rosacea is essential for effective management of ocular manifestations.

The symptoms of ocular rosacea vary dramatically. Burning and irritation of the eyes and eyelids may be accompanied by blepharitis, or swelling, inflammation, and dandruff-like debris in the eyelids. Conjunctivitis, also commonly called pink eye, is also quite common, as are sties. Iritis, or inflammation of the iris, can also occur, causing eye pain, light sensitivity, and blurry vision. Some patients may develop chalazia, or small tumors on the eyelids as well. In more severe cases, the cornea may be affected, leading to infections, corneal ulcers or neovascularization — abnormal growth of the blood vessels.

Although many people with ocular rosacea have a history of facial rosacea, approximately 20 percent will present with ocular inflammation independent of facial symptoms. In addition, severity of the ocular manifestation is not necessarily proportional to the severity of facial rosacea, and while women are twice as likely to experience facial rosacea, men and women are equally affected by ocular rosacea.

On the most basic level, ocular rosacea occurs when the meibomian glands, located at the rim of the eyelids, become blocked. Beyond that, the cause of the condition is highly debatable. Although facial rosacea is a dermatological disease, ocular rosacea is an ophthalmological manifestation. Patients experiencing symptoms typically are referred to an ophthalmologist. Ongoing collaboration between the dermatologist and the ophthalmologist in treating the disease is common.

Eye dryness is responsible for many of the complaints and symptoms of ocular rosacea. Over-the-counter eyedrops and warm compresses can provide symptomatic relief for mild cases. Gentle cleansing of the eyelids, using a cotton swab moistened with a mixture of warm water and baby shampoo, may also be recommended. However, dry eyes are also a breeding ground for bacteria, which can cause infections. In such cases, tetracycline antibiotics, especially doxycycline, may be prescribed. Topical steroids may also be prescribed for short-term therapy. More severe cases may require eyelid tumors to be drained or other in-office procedures. Early diagnosis is important to avoid serious complications, and patients should seek medical treatment as soon as symptoms arise.