THE EYES HAVE IT

Studies suggest that eye (ocular) symptoms may occur in over half of rosacea patients, and 12 to 20 percent of ocular rosacea patients reported they developed their eye symptoms before developing any facial rosacea symptoms. On the other hand, facial redness is one of the most common symptoms of rosacea, and frequently appears before other signs and symptoms develop. Medical therapy can be tailored to control various signs and symptoms, and may also prevent rosacea from getting worse.

Who Gets Ocular Rosacea

Approximately 60% of patients with rosacea develop related problems affecting the eye (ocular rosacea). Patients with ocular rosacea most commonly experience irritation of the lids and eye, occurring when the oil-producing glands of the lids become obstructed. Signs and symptoms of ocular rosacea can include chronically red eyes and lid margins, irritated eyelids (blepharitis), styes (chalazion), dry, irritated eyes, burning, and the sensation of a foreign body in the eye. Ocular rosacea may also affect the cornea, causing neovascularization (abnormal blood vessel growth), infections, and occasionally ulcers.

Ocular Rosacea Underdiagnosed

A survey by the National Rosacea Society suggests that common symptoms known as ocular rosacea, which can cause irritation or redness in the eyes of rosacea patients, may be significantly under diagnosed.Out of 1,780 rosacea sufferers reporting ocular symptoms, 86 percent said their eyes had appeared watery or bloodshot and 95 percent said their eyes had felt dry, gritty or irritated. Of those with watery or bloodshot eyes, only 29 percent said they had been diagnosed with ocular rosacea. Of those experiencing dryness, grittiness or irritation, only 28 percent said they had been diagnosed.One of the reasons ocular rosacea may often go undetected is the fact that these symptoms tend to develop separately from the facial symptoms of the disorder. Thirty-eight percent of the survey respondents said their ocular symptoms developed after their facial symptoms, while 17 percent said they occurred before. Only 15 percent said eye and facial symptoms appeared at the same time, and 22 percent were unsure."Many people may not connect their eye symptoms with a skin disorder, and sometimes an ophthalmologist will be the first one to notice rosacea and point the patient to a dermatologist," said Dr. Guy Webster, associate professor of dermatology at Thomas Jefferson University Medical College in Philadelphia. "Ocular rosacea may be far more common than is generally recognized, and in clinical studies it has occurred in as many as 58 percent of rosacea patients."The symptoms of ocular rosacea are often mild, and may be considered minor annoyances by many patients. Some patients, however, feel as though there is an eyelash or something gritty or foreign in their eye. In severe cases, ocular rosacea may include swollen blood vessels, inflammation of the eye or eyelid, irritation or scaling of the mucous membrane, and in rare instances even impairment of vision.The good news is that medical therapy appears to be widely effective in improving the symptoms. Of the survey respondents who had been diagnosed with ocular rosacea, 88 percent said they had received treatment, and 90 percent of those treated said their condition had improved.Once diagnosed, a physician will usually prescribe a combination of treatments for ocular rosacea tailored to the individual. This may include local and systemic therapy, as well as cleansing and tearing agents, all of which may be adjusted over time.

Tips for Treating Ocular Rosacea

Physicians usually treat ocular rosacea with oral antibiotics and other therapies. In addition, a number of steps can be taken to help soothe and prevent irritation and discomfort.

Drink plenty of fluids. Dehydration results in a dry eye effect causing increased irritation and eye redness.

Clean carefully the area surrounding the eye. Just as with a facial care routine, daily eye care starts with removing all eye makeup, using a gentle, non-abrasive cleanser and rinsing with lukewarm water several times to make sure the eye area is completely clean. Blot dry gently with a soft cotton towel. After the eye area air-dries for a few moments, use a gentle moisturizer on the lids and underneath the eyes.

Ask your doctor about using a tearing agent. If eye dryness or a gritty feeling is a problem, talk to the doctor about using a special agent to moisten the eyes. Preservative-free artificial tears applied several times a day can help eliminate that dry, gritty feeling. Do not use any over-the-counter products for red or irritated eyes unless the doctor recommends it.

Apply warm compresses and gently massage the eyelids. Not only will this feel refreshing, but massaging the eyelids will help loosen any debris in the tear glands and stimulate circulation.
This can be especially soothing after a long day at work, or being outside in the cold and wind.

Wear UV sunglasses outdoors. They protect your eyes from harmful rays of the sun, and act as a shield against wind and other elements. Sunglasses without UV protection may actually make the condition worse.

Ocular Rosacea Can Threaten Sight

While red, teary or scratchy eyes might sometimes be shrugged off as simple irritation from harsh winter weather, these may actually be warning signs of ocular rosacea, a potentially serious condition that many people do not associate with a skin disorder.

"The effects of rosacea on the eyes may easily be overlooked because they often develop after, and sometimes before, the disorder affects the skin," said Dr. Bryan Sires, associate professor and acting chair of ophthalmology at the University of Washington. "In most cases, ocular rosacea is a mild, irritating condition, but it can develop into a permanently debilitating one -- including loss of vision -- without proper care."
Although as many as 58 percent of rosacea patients have been found to have ocular symptoms in clinical studies, he noted that the condition may be easily controlled if diagnosed and treated before it becomes severe.

An eye affected by rosacea often appears to be watery or bloodshot. Patients may feel a gritty or foreign body sensation in the eye, or have a dry, burning or stinging sensation.