Ocular rosacea is a form of rosacea that affects the eyes, causing red, watery eyes that feel dry and sensitive. It often affects people who have rosacea on their face, but not always.

An eye exam machine shines light into someone's eye to detect signs of ocular rosacea.Share on Pinterest
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Ocular rosacea is much less common than rosacea of the skin. Experts estimate that around 5.46% of the adult population lives with rosacea, while ocular rosacea affects 0.4% to 1% of individuals.

This article looks at ocular rosacea and its symptoms. It also explores treatment options and when an individual should contact a doctor.

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Ocular rosacea is an inflammatory condition of the eyes that causes redness, burning, and watering. It is one of the most common conditions affecting the eyes’ surface.

This condition often affects individuals who have rosacea, a chronic skin condition that causes the face to flush and develop acne-like breakouts. In 15% of all rosacea cases, ocular rosacea occurs first, causing eye symptoms before affecting the face. But people can also have ocular rosacea on its own without skin symptoms.

People of all ages may develop ocular rosacea, although doctors most commonly diagnose it after age 30 years and usually between ages 40–59 years. Females are more likely than males to have rosacea, although this may be reflective of females being more likely to seek health advice.

Doctors associate the following symptoms with ocular rosacea:

Doctors do not know the exact cause of ocular rosacea. But in almost 58% of cases, ocular rosacea is linked to skin rosacea. Some of the factors that may contribute to ocular rosacea include:

  • Bacteria: Ocular rosacea can sometimes improve with antibiotics, which may decrease inflammation at low doses.
  • Inflammation: Inflammatory substances in the body known as cytokines can cause a wide variety of diseases. The cytokine interleukin 1-alpha (IL-1α) increases a protein in tears that can inflame eye tissues.
  • Mites: Demodex mites are tiny organisms that often live in eyelash follicles. In some people, they can stimulate inflammation or block the glands of the eyelids.
  • Genetics: Rosacea affects people of all skin tones, but is more common in white people. Researchers believe this may indicate a genetic link, but they have not identified any specific gene that is associated with rosacea.
  • Other conditions: While researchers have not established a causal link between other conditions and rosacea, it is associated with other diseases. These include high cholesterol, high triglyceride levels, gastrointestinal disorders, and autoimmune diseases such as rheumatoid arthritis.

For people with rosacea, certain triggers can cause a flare-up of symptoms. Some examples of common rosacea triggers include:

  • exposure to heat, sun, wind, or cold
  • strenuous activities such as running
  • drinking alcohol, hot coffee, or tea
  • eating spicy foods or dairy products
  • emotional stress

Doctors base an ocular rosacea diagnosis on clinical symptoms. For example, a doctor may suspect that an individual has ocular rosacea if they already have skin rosacea.

But a doctor may find it more challenging to diagnose the condition if the individual does not have skin symptoms, as ocular rosacea can look similar to other conditions. For example, a person can develop blepharitis due to seborrheic dermatitis, which is a form of eczema caused by yeast.

In these cases, a doctor may consider other factors, such as a family history of rosacea, when making their diagnosis. They may also test for associated conditions, such as an H. pylori infection, to determine if ocular rosacea is likely.

There is no cure for ocular rosacea, but medications can help control the symptoms. It is important to work with a doctor to manage the condition, as ocular rosacea can cause vision changes if it is severe and left untreated.

Treatment may include a combination of management techniques, topical treatments, or medications.

Conservative management

These techniques are noninvasive and easy to do at home. They can reduce the symptoms of ocular rosacea and make the eyes more comfortable. They include:

  • Warm compresses: Close the eyes and apply a warm compress for 5–10 minutes each day. This improves the flow of eyelid gland secretions and helps with chalazia or styes.
  • Eyelid hygiene: An individual should try to keep the eyelids clean and free from skin scales along the eyelashes. To maintain eyelid hygiene, they can use a specially made solution, diluted baby shampoo, or a bicarbonate solution. Apply gently with a cotton bud over the eyelid and along the lash line.
  • Artificial tears: Individuals can purchase artificial tears to lubricate the eyes and reduce dryness. It is possible to store them in the refrigerator so that the drops have a cooling effect. Do not use eye drops made for reducing bloodshot eyes – these can make rosacea worse.

People with ocular rosacea also need to avoid wearing contact lenses, as they can further irritate the eye.

Topical treatments

A doctor may recommend applying a topical antiseptic or antibiotic to the eyes, such as:

  • azithromycin
  • bacitracin
  • erythromycin
  • metronidazole

The doctor may also recommend topical steroids for short-term use. These medications can help with lid inflammation, but they are not suitable for long-term use as they can lead to glaucoma and cataracts.

If ocular rosacea does not respond to topical steroids, a doctor may suggest topical cyclosporin.

Systemic medications

People can also take antibiotics orally to reduce bacteria on the skin. This may mean taking a tetracycline, such as doxycycline, or macrolides, such as erythromycin.

A person may take oral antibiotics for 6–12 weeks and then reduce the dose over two months. They may also require additional oral antibiotics if they experience a flare-up.

If an individual has a stye that becomes infected, a doctor may recommend an oral antistaphylococcal antibiotic, such as flucloxacillin.

Doctors may also recommend oral retinoids to treat ocular rosacea symptoms. But the side effects may make symptoms worse.

Some individuals with dry eyes benefit from oral omega-3 fatty acid supplementation.

Surgery

Surgery can be part of ocular rosacea if someone develops complications from the condition. For example, if someone develops a stye that does not get better, a doctor may suggest excising or surgically removing it.

Recurrent styes and chalazia are a potential complication of ocular rosacea. Rarely, people can also develop an inflamed cornea in one or both eyes. The cornea is the transparent film covering the pupil and iris.

Cornea inflammation is known as keratitis, and it is a severe complication. With recurrent attacks of keratitis, the cornea becomes thinner and more opaque as more blood vessels form. In extreme cases, it can lead to vision loss, deep ulcers, or perforation of the cornea.

If someone develops a whitened or perforated cornea, a doctor may recommend a keratoplasty, or cornea transplant. This replaces some of the cornea with tissue from a donor.

Other complications include:

  • inflammation of the iris
  • inflammation between the conjunctiva and cornea
  • inflammation of the white of the eye

If an individual develops any of the signs or symptoms of ocular rosacea, they should speak with a doctor. Their doctor may prescribe treatment or refer them to a specialist eye doctor called an ophthalmologist.

Ocular rosacea is an inflammatory condition of the eyes that causes redness, inflammation, eye watering, and other symptoms. It often occurs in people with skin rosacea, but not always. Doctors do not fully understand what causes it, but genetics, microbes, and other health conditions may play a role.

Ocular rosacea currently has no cure, but various treatments can help manage individuals’ symptoms. These may involve conservative treatments to keep eyelids clean and reduce irritation, as well as topical or oral medications.

Anyone experiencing the symptoms of ocular rosacea should speak with a doctor, as prompt treatment reduces the chances of complications.