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The lowdown on ocular rosacea and how best to treat it

Are your eyes often red, watery, gritty or light sensitive? Then it's probably time you focused on the inflammatory condition ocular rosacea

Rosacea, the facial condition characterised by redness, flushing, irritation and itchiness, is a very common skin condition affecting an estimated five per cent of people worldwide. But did you know that it can also affect your eyes?

The inflammatory condition ocular rosacea presents with a number of signs and symptoms including itching, burning and stinging; watery eyes; inflamed eyelids and styes (blepharitis); red or bloodshot eyes (conjunctivitis); light sensitivity; a feeling that something is in the eye (foreign body sensation), and visible blood vessels (telangiectasia) on the eyelids or whites of the eyes.

In some patients the meibomian glands, which secrete an oil that helps keep the eye moistened, become clogged, causing tears to break down faster, leading to dry eye syndrome – the eyelid margins can reveal hallmark features including meibomian gland dysfunction (MGD), along with blepharitis, and debris on the eyelid margin and eyelashes.

A recent NRS survey of 609 rosacea patients revealed that 73 per cent had experienced many of the signs and symptoms of ocular rosacea, including 76 per cent with dry eyes, 64 per cent with a gritty foreign body sensation or itching, and about half with light sensitivity, burning, or stinging.

Forty-six per cent reported red or bloodshot eyes, 41 per cent said they had visible blood vessels in their eyes and 43 per cent had watery eyes. About 28 per cent reported meibomian gland dysfunction and 25 per cent had styes or chalazia (red bumps on the eyelid), while 15 per cent experienced conjunctivitis.

Fortunately, only six per cent reported scarring on the cornea, a severe condition that can cause vision problems.

What causes ocular rosacea?

According to EV Expert, Thames Skin Clinic Founder and rosacea sufferer, Dr Anna Hemming, causes include environmental factors, bacteria, genetics, eyelash mites and blocked eyelid glands, while flare ups can be associated with “all kinds of things, including saunas or hot baths, spicy food, hot drinks, caffeine, chocolate, cheese, alcohol, intense sunlight, wind, emotions and hard exercise.”

Who does ocular rosacea affect?

Ocular rosacea can be found in conjunction with facial rosacea – it's estimated that about half of people with rosacea will go on to experience eye-related symptoms – or before it develops, but it can also be a standalone diagnosis.

While it can affect anyone, including people with darker skin and skin of colour, you’re more likely to develop ocular rosacea if you are a female between the age of 30 and 50, have fair or light skin, and are of Northern or Western European descent.

What treatments can help relieve symptoms?

Ocular rosacea is a chronic disease with no permanent cure. The most common treatments and therapies prescribed for managing the condition include a combination of artificial tears, oral doxycycline (an antibiotic), and corticosteroid-antibiotic ointment, alongside a lid hygiene regime including warm compresses and washing eyelids with a pH balanced cleanser.

And remember the three s’s which may also help – limiting sun exposure, managing stress and getting enough sleep.

The NRS survey showed that medical therapy relieved ocular rosacea signs and symptoms for 19 per cent of sufferers and was somewhat effective for 52 per cent, while 28 per cent noted medical therapy did not help.

Treatments used to provide relief included saline solution or artificial tears (72 per cent), warm compresses (67 per cent) and baby shampoo on the eyelids (39 per cent). Other measures included oral antibiotics (37 per cent), antibiotic eyedrops (24 per cent) and antibiotic ointment (23 per cent).

See below for more in clinic and at home solutions.

Is ocular rosacea detrimental to the eyesight?

Most of the time symptoms can be managed, however if the meibomian glands become blocked and the condition worsens, the cornea may become damaged, leading to reduced visual clarity.

In a recent study in Argentina, three patients taking part in an ocular rosacea study required corneal transplants to restore their vision. The researchers recommended that special attention be paid to worsening eye symptoms during flare ups of rosacea on the skin, and that patients should be referred to an ophthalmologist for treatment when vision is threatened.

In clinic solutions

IPL (intense pulsed light) is commonly used to treat facial veins affecting some facial rosacea patients, however its use as a treatment for ocular rosacea has gained popularity, with studies showing the benefits of using IPL to treat dry eye.

While there are lots of IPL devices on the market, treatment is not widely available. Lumenis Optilight is the first IPL device to gain FDA approval for dry eye and meibomian gland dysfunction: an initial course of four treatments is recommended, followed by intermittent treatments at six monthly intervals.

Or you could try a treatment called Meibomian Gland Expression which will unblock the small obstructions that are blocking your meibomian glands, causing their dysfunction. The treatment is quick and not painful.

At home treatments

While diet isn’t going to eliminate symptoms altogether, some supplements have shown to help. In 2021, researchers published a review in the Journal of Clinical and Aesthetic Dermatology highlighting the findings from studies on the effects of foods on rosacea.

They found that omega 3-fatty acids consistently showed benefits for patients with ocular rosacea, which improved dry eye symptoms. “Fatty acid supplements can help as they can stabilise the meibomian glands in the eyelids,” agrees Aesthetic Doctor and GP Dr Usman Quereshi.

Along with regular gentle eye massage and warm compresses which will help to remove any blockages in the eye glands, you could also try Purifeyes, a pH balanced cleanser and antimicrobial which was developed in conjunction with leading ophthalmologists to help reduce microbial overgrowth and inflammation that leads to long term dry eye symptoms and blepharitis.

We also like Blephaclean Eyelid Wipes, which are a great option for travelling or busy lifestyles.
For something a little more pampering, Peep Club’s innovative Heated Eye Wand, which is recommended by optometrists and eye specialists, can help soothe and hydrate dry eyes thanks to its effectiveness in stimulating the meibomian gland.

Anna Hemming, Aesthetic Doctor

Dr Anna Hemming MBChB BSc DFFP MRCGP is a highly respected and skilled aesthetic doctor working in London. Conference...

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