Nutritional Supplements Can Improve Ocular Rosacea Symptoms

The main action of nutritional therapy is to reduce ocular inflammation. Excess free radicals on the eye surface can cause eye inflammation by dilating surface blood vessels and disrupting the tear film layer. Increased oral intake of free radical scavengers (antioxidants) may play a role in decreasing eye surface inflammation and preventing damage to surface blood vessels:
Antioxidants that have Anti-Inflammatory Actions in the Eye:
• Ester-C: Ester C is a form of vitamin C that is gentle on the stomach and highly bio-available. It is recommended that rosacea sufferers slowly work their way up to 1,000 to 3,000 milligrams per day (in divided doses)
• Grape Seed Extract: Grape seed extract is one of the most powerful antioxidants known to science. It is recommended that rosacea sufferers slowly work their way up to 150 to 300 milligrams per day (in divided doses).
• Pycnogenol: Pycnogenol has very similar actions to grape seed extract. It is recommended that rosacea sufferers slowly work their way up to 50 to 200 milligrams per day (in divided doses).

Essential Fatty Oils:
• Borage Seed Oil: Supplementation with essential fatty oils such as gamma linolenic acid, the active ingredient in borage seed oil, may be beneficial to patients with ocular symptoms. Gamma linolenicacid (GLA) has two interesting mechanisms of action in thetreatment of ocular disorders:
(1) GLA supplementation decreases ocular inflammation, and
(2) GLA supplementation increases mucous production from goblet cells, resulting in a more stable tear film layer.

Oral Antibiotics for Treating Ocular Rosacea

Oral antibiotics are very effective at reducing ocular rosacea symptoms. Oral antibiotics have several important actions in the treatment of ocular rosacea:
• They stabilize the tear film.
• They improve oil secretion from meibomian glands.
• They decrease eyelid inflammation.
• They reduce eyelid bumps (chalazia and styes).
• They decrease the leakage of inflammatory cells through blood vessels of the eye.
• They decrease eye surface flushing and inflammation (for some unknown reason, antibiotics are quite effective against the vascular symptoms of the eye).

Tetracycline Antibiotics. Oral tetracycline is very effective at reducing the symptoms of ocular rosacea. Systemic tetracyclines decrease eye surface inflammation, improve meibomian gland oil secretion, improve the stability of the tear film layer, reduce aqueous tear film evaporation, and improve the health of the ocular surface. In most cases, symptom improvement is noted within 4 weeks of treatment (standard dosage would be 250 milligrams 4 times a day).

Doxycycline. Ophthalmologists treat many of their ocular rosacea patients with doxycycline due to its anti-inflammatory actions and its positive effect on meibomian glands. Doxycycline (standard dosage would be 50 or 100 milligrams 2 times a day) is very effective at reducing ocular rosacea symptoms, and in some cases may be more effective than standard tetracyclines.

Recommended Eye Lid Scrubs

Daily eyelid scrubs are one of the most important parts of the ocular rosacea treatment regimen. Ophthalmologists who specialize in ocular rosacea stress that meticulous eyelid hygiene must be performed daily (and sometimes twice daily) in order to keep this chronic disorder under control.

Proper eyelid hygiene can relieve most eyelid and eye surface symptoms:
• It removes eyelid crusting, scaling, and micro organisms (yeast &;bacterial)
• It decreases eyelid inflammation, itching, and burning sensations.
•It increases tear film stability by unblocking meibomian glands and increasing flow of protective oil.

General physicians routinely recommend that patients use "home-made"cleansing solutions with diluted baby shampoo to cleanse their eyelids. These "home-made" cleansing solutions work fairly well on simple cases like dry eye and eyelid crusting, but these solutions are not advisable for all ocular rosacea sufferers. First of all, diluted baby shampoo causes eye irritation and stinging in many ocular rosacea sufferers. Second, diluted baby shampoo is not as effective as ophthalmologist-designed eyelid scrubs. For these reasons, medical experts strongly recommend that ocular rosacea sufferers use commercially available eyelid scrubs.

Recommended Eyelid Scrubs for Ocular Rosacea.
Ocusoft Eyelid Scrub for Sensitive Eyes (Ocusoft Inc.)b. Eye Scrub Sterile Eyelid Cleanser
(Ciba Vision Ophthalmics)Methods for Thorough, Gentle Eyelid Cleansing• Eyelid Scrubs with Q-tips (cotton swabs).

It is highly recommended that ocular rosacea sufferers apply eyelid scrub solution onto a Q-tip and gently cleanse their upper and lower eyelids. Q-tips are recommended because they aid in removing crust and debris from the eyelid. The eyelid skin is very delicate, so close the eyes and use gentle side-to-side strokes across the eyelid margins and lashes, being careful not to rub harshly or irritate the skin. Patients should cleanse each eye for 30 to 60 seconds. Lather from the eyelid scrub should then be rinsed off or removed gently with a tissue. This method is also effective for removing eye make-up and mascara.

Eyelid Scrubs with Pre-Moistened Pads. Most commercial eyelid scrubs are also available in convenient pre-moistened cotton pads that are easy to use and lather up very quickly. For those sufferers who cannot safely use Q-tips around the eye, pre-moistened pads are an excellent choice for eyelid cleansing.

• Note: Medical experts stress that eyelid scrubs should become a
permanent part of the patient's routine. Patients should consider daily eyelid scrubs as important as washing their faces and brushing their teeth. Disciplined eyelid cleansing will make a difference in ocular rosacea symptoms.

Ocular Treatment for Your Eyes

The best ocular treatment for your eyes occurs when you go to the physician with a prepared list of your symptoms, concerns and current medications and observations of your condition.
Rosacea sufferers can help their physicians by answering a few key questions such as:
• Do your ocular symptoms get worse during bouts of facial flushing?
• Are your ocular symptoms the most troublesome in the morning, or do they get worse as the day progresses?
• Do you experience blurred vision, eye pain, or vision loss?
• What are your most bothersome symptoms?
• Do you wear contact lenses and if so, what type?
• What medications are you currently taking (include a complete list)?

Summertime Tips for Ocular Roscacea

Those with ocular rosacea need to pay particular attention to eye care in the summertime.
Ways to protect you eyes include:

1) Sunglasses with UV blocking lenses can help shield eyes from UV rays in sunlight. However, even most sunglasses that offer UV protection block only about 50% of UV radiation – because sunlight also enters the eye from above and around the sunglasses. Good colors for sunglasses are gray, green or brown. Gray lenses do not distort primary colors so they are good for driving. Green lenses let the maximum amount of useful light reach the eyes on an overcast day, and brown lenses sharpen detail and provide better protection against glare. Those labelled "EPF 10" (Eye Protection Factor rating 10) actually exceed the requirements of AS 1067 and thus provide even greater protection. Others may be labelled "absorbs 100% UVR" these should also carry the AS 1067 label.
2) Wearing a broad brimmed hat with sunglasses can further reduce exposure to UV rays. Wrap-around frames protect your eyes from all angles and are a good choice if you are in the sun all day. Polarized lenses cut reflected glare, and are perfect for skiing, boating and the beach.
3) Wearing UV blocking contact lenses in conjunction with sunglasses.
4) Minimize sun exposure at midday (10:00 a.m. to 4:00 p.m.)
5) Avoid sunlamps, tanning beds and tanning parlors.
6) UV Blocking Contact Lenses Help Protect from the Sun. Contact lens wearers have a means of protection from damaging UV rays – UV blocking lenses, which filter UV radiation. The U.S. Food and Drug Administration (FDA) recently approved a new indication that ACUVUE® UV blocking contact lenses "help protect against transmission of harmful UV radiation to the cornea and into the eye." However, clinical studies have not been done to demonstrate that wearing UV blocking contact lenses reduces the risk of developing cataracts or other eye disorders.

NOTE: The American Optometric Association warns that UV blocking contact lenses are not a replacement for UV absorbing sunglasses. However, the AOA acknowledges that, when worn with sunglasses, UV blocking contact lenses provide protection by blocking much of the UV rays that reach the cornea and that get into the eye through the open spaces at the top, bottom and sides of sunglasses.