What is ocular rosacea and could it be the underlying cause of your dry eye syndrome? And if so, can treating it improve your symptoms and give you back your quality of life?
What, exactly, is rosacea?
Whether it affects the eyes or the face, rosacea is a skin condition. In facial rosacea, the tiny blood vessels of the facial skin become enlarged (spidery looking) and cause a permanent flush across the nose and cheeks. Pimples occur on forehead, cheeks and chin and skin may feel hot. Particularly in older people, the nose and cheeks may become swollen.
What happens in the eye?
Rosacea can also affect the skin of the eyelids. The capillaries of the eyelids become enlarged and cause the skin to become engorged. This can interfere with normal production of oily tears in the oil glands of your eyelids – the meibomian glands. Rosacea may affect the eyelids at different times to the face, or just one or the other.
So, what’s the cure?
There’s no silver bullet to ‘cure’ ocular rosacea. For many sufferers, the biggest challenge is simply getting diagnosed in the first place. We’ve lost count of the number of people we’ve seen who remain undiagnosed after years of misery.
Just as common is misdiagnosis – where you’re told you have blepharitis or meibomian gland dysfunction (MGD) while the underlying cause – i.e. the rosacea – is missed.
The good news is that, with accurate diagnosis and appropriate therapy, ocular rosacea can be kept under control. This may involve a multi-pronged approach including oral tables, dietary changes and lid hygiene, rather than simply adding more eye drops to your list.
How is rosacea managed?
When you can, avoid known triggers, including hot beverages, alcohol and sunburn. Certain diet choices are believed to cause flare-ups, including chocolate, spicy food and wine (yes, we know – all the good things). Stress and anxiety can also aggravate this condition.
Many people with rosacea have gut health issues. They often have an imbalance of gut bacteria – which leads to chronic gut issues, including irritable bowel syndrome etc.
Sorting out the gut can improve the rosacea. A good probiotic can really help. We recommend our ocular rosacea patients take a high-quality probiotic such as Bioceuticals, which has a high number of bacteria and specific strains that target inflammation and leaky gut.
A popular and effective treatment for rosacea (facial or ocular) is a three-month course of oral antibiotics called doxycycline. This drug changes the composition of the oil inside the oil glands of there skin and eyelids, leading to improved function. About two thirds of people have a long period of improvement as a result of this therapy. But one third tend to relapse within a few months and may need to look at other treatments.
It’s not suitable for use if you are pregnant, trying to become pregnant or breastfeeding. It also makes the skin more sensitive to sunlight, so you have to avoid strong sunlight while taking it.
Another oral table, called azithromycin, may be an alternative to doxycycline and is only used for 7-10 days. This may be preferable for people who can’t take doxycycline or who are put off by having to take it for a three-month course.
Intense pulsed light (IPL)
People often ask us if IPL will help their dry eyes. The answer is often no, but when ocular rosaea is one of the contributing causes of the dry eye disease, a series of 2 or 3 in-house treatments of IPL can be effective. If you don’t have ocular rosacea, it is our experience that IPL will do little in anything to improve your dry eye symptoms.
If you have anterior blepharitis as well as ocular rosacea, a Blephex treatment can kick-start management.
This is a professional in-house treatment that removes the layer (or biofilm) of bacteria present on the margins of the eye lids.
It is a quick and effective way to get on top of blepharitis and can be complimented with your own lid-hygiene routine at home.
Had enough of red, sore eyes? Call The Eye Practice on (02) 9290 1899 or make an appointment online today.