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Ocular Rosacea

Ocular Rosacea

 

Rosacea is a well-recognised inflammatory condition that affects {the} middle of {the} face. One in 10 individuals in {the} United States suffer from this condition with over 60% of them experiencing complications that affect {the} eye (called ocular rosacea). Other parts of {the} face such as {the} cheeks, forehead and chin are also commonly involved. In this article, we shall take a brief look at rosacea and its clinical manifestation when it affects {the} eyes.

Overview

  • rosacea is a disease of increased vascular reactivity
  • people who get rosacea blush and flush easily
  • about 50% of patients with skin rosacea also have ocular rosacea
  • rosacea is a common cause of blepharitis

Cause of rosacea

The exact cause of rosacea is not known. It is believed that it occurs due to altered immune responses within {the} body and {the} production of a number of different mediators that promote inflammation. Certain bacteria such as Staphylococcus epidermidis have been implicated as a trigger. A stomach bug known as Helicobacter pylori has also been associated with it. Exposure to ultraviolet light seems to be a risk factor. Patients who have a strong family history of rosacea are prone to developing this condition. Smoking is also a well-known risk factor.

Clinical features

From a more general perspective, patients experience redness of {the} face and {the} eruption of small pus filled lesions. They could also develop multiple episodes of flushing of {the} face. With regards to {the} eyes, there can be irritation, redness and burning sensation of {the} eyes. Patients could feel like there is a foreign body within {the} eye and could also experience dry eyes. Recurrent eye infections are common as are {the} formation of styes. Excessive thick secretions from {the} meibomian glands will be present. Patients could become sensitive to light.

On examination, {the} eyelid demonstrates excessive redness and prominent blood vessels (called telangiectasia). Patients could also develop conjunctivitis and infiltration of {the} cornea. Thickening of {the} cornea could also occur at certain parts. If left untreated, {the} cornea can become opaque and can distort {the} patient's vision. On top of this, patients could develop bacterial keratitis.

Diagnosis

Clinical examination is {the} best diagnostic modality. No specialist investigations are usually needed though histology could show {the} presence of various inflammatory cells in {the} conjunctiva.

Treatment

Symptomatic treatment is {the} primary modality. Patients are advised to avoid triggers such as excessive exposure to sunlight, alcohol and spicy foods. Any thick secretions from {the} meibomian glands located in {the} eye can be expressed using hot compresses. Artificial tears could be required to lubricate {the} eye.

Antibiotic eye drops that contain tetracyclines (tetracycline, doxycycline) are very effective. Their primary action is on {the} bacteria that cause excessive secretions in {the} eye. Side-effects include diarrhoea and pancreatitis, though these are rare. Oral antibiotics are not offered to patients who do not have any symptoms. The dose of tetracyclines that is used is a lot less than what is used for an infection elsewhere in {the} body. Other antibiotics that could be used are azithromycin, clarithromycin and metronidazole. The latter is not very useful for rosacea that involves {the} eyes.

Steroid eyedrops have also been used to manage eyelid disease, but are used with caution. Treatment of Helicobacter pylori could be required.

In cases where medical treatment is not enough, surgical treatment could also be offered. This includes procedure such as keratoplasty to manage {the} corneal disease and reconstruction of {the} cornea using amniotic membrane.

Effective treatment

  • oral doxycycline or oral minocycline
  • rosacea often progresses to bumps and pimples
  • irradiation of {the} skin with ultraviolet light could help

Conclusion

Ocular rosacea is a fairly common condition affecting {the} eyes. Diagnosis is clinical and various treatment options are now available.

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