Inflamed, red eyes can start with the skin.
Ocular Rosacea is a chronic inflammation of the skin around the eyes and the ocular surface. It causes a range of symptoms including redness, burning and itching.
Sometimes ocular rosacea may be an early sign that you may develop facial rosacea – a chronic redness of the skin of the face. It is most common in adults aged 30-50 but is also common in older people.
The condition can be managed (rather than cured) with medication, professional treatments and good eye-care habits. Rosacea occurs in 1-10% of the general population, with a higher incidence of the disease in some races and colourings (such as people with red hair and freckled skin). Ocular rosacea appears in 20-50% of people with facial rosacea. Both are also associated with people who blush easily.
The condition is closely associated with dry eye.
Causes and irritants
The exact mechanisms of the inflammation seen in rosacea are not well understood. What tissues become inflamed? Skin, blood vessels or nerves? Some doctors believe rosacea is a vascular disorder (i.e. of the blood vessels) because of the tendency to see it in ‘blushers’ as well as the presence of red blood vessels in the facial / eyelid skin and the eyes. Others think it may involve the nervous system (as it is often triggered by emotional stress). Yet another theory is that increased blood flow (due to blushing) increases fluid in the skin of the face and eyelids, and that fluid cannot be cleared as quickly as it accumulates. This leads to thickening of the skin. Rosacea is most often seen in association with increased oil production in the oil glands of the skin and eyelids.
Chronic inflammation is difficult to pin down to a particular cause. It is often caused by a combination of
- hereditary (or genetic) factors (which you can’t do anything about) such as skin type and colouring
- environmental triggers (such as infections, certain foods, cold weather)
Another factor in the underlying cause of ocular rosacea is the presence of above-normal levels of eyelash mites called Demodex mites. This mite is a normal part of our biome – much like the bacteria that naturally inhabit our gut. Demodex mites live around hair follicules and oil glands and consume cast-off cells. But they are found in far higher numbers in rosacea patients. It is not known if this is a cause or result of the condition. Part of the management of rosacea centres on controlling these mites.
Irritants that aggravate rosacea (including ocular rosacea) include…
- Tea and other caffeinated drinks
- Heavy exercise
- Steam rooms and hot baths
- Certain medications (including steroids)
- Cold weather
- Sun exposure
- High emotional state (anxiety, anger etc)
Symptoms of ocular rosacea
You may get symptoms of ocular rosacea before or after the symptoms of facial rosacea appear, or you may only develop one type or the other.
- Inflammation and redness of the eyelids
- Dry eyes (gritty feeling)
- Burning sensation
- Blepharitis (inflamed lids)
- Red, bloodshot eyes
- Blurred vision
- Sensitive, teary eyes
- Loss of eyelashes
- Corneal complications (can lead to visual symptoms)
Ocular rosacea is diagnosed through clinical observation, symptoms and medical history.
Ocular Rosacea Treatment
The condition usually needs to be managed long-term, and there is no quick-fix or cure.
These include low dose oral antibiotics, such as doxycycline and erythromycin. Even though rosacea is not an infection, these drugs have positive effects on the tissues of the skin and eyes.
In-house professional treatments
- IPL: Intense Pulsed Light can be used to target the inflamed blood vessels characteristic of rosacea in the face and around the eyes. 3 treatments are usually required to see results.
Rosacea is essentially an immune response to an altered make up of the oil in your oil-glands. Supporting the immune system through healthy food choices and lifestyle changes can reduce symptoms.
Demodex mites are present in the hair follicles and oil glands of all adults. But rosacea patients have higher numbers of these microscopic mites. The mites are found in a special form of dandruff often seen on the eyelashes of ocular rosacea patients. Mites around the eyelash follicles can be managed with tea-tree oil wipes and can be physically removed with a procedure called BlephEx.
Ocular rosacea is best managed when everyone works together. There are lots of things you can do at home to help manage your symptoms:
- Use a product (such as Blephadex) daily to maintain good lid hygiene.
- Choose non-oily makeup specially designed for sensitive eyes.
- If your ocular rosacea has fared-up, avoid eye makeup until it settles.
- Avoid known triggers (such as caffeine or alcohol).
- Use artificial tears to relieve dryness according to your dry eye specialist’s instructions.