Simply Ocular Rosacea

In all simplicity, ocular rosacea is a combination of dry eye and ocular inflammation. Surprisingly, relieving the dry eye symptoms usually results in substantial improvement of ocular rosacea.

One of the main complaints that ocular rosacea sufferers complain of is blurry vision. In 99% of the cases this actually has nothing to do with vision loss. It has to do with a disturbance in the three layers of moisture on your eye surface (mucus, water and oil).

This(and sometimes the inflammation) plays a role. Good treatment focuses on getting back a normal tear film layer first, then seeing what happens.

ARTIFICIAL TEARS are one of the best things you can do for your eyes.While treatment for ocular rosacea is usually multifactorial, several studies have shown that daily use of artificial tears for three to four months can help the tear film stabilize by decreasing ocular irritation.

Then patients can sometimes stop immediately or just use them upon flare ups. PLEASE DON'T USE VASO-CONSTRICTOR EYEDROPS!

The challenge is to find the right eye drop for your eye. The eye vessels in general are a lot more forgiving then the facial vessels.

Many folks recommend Refresh Plus Drops for Sensitive Eyes or Thera Tears eye drops, which are preservative free.

In many cases, the normal eye drops are not strong enough. That is why the leaders in the industry have made gel drops. Several of these gel drops by themselves have been shown to improve the entire tear film layer, stabilize the water concentration and electrolyte balance, and reduce some forms of inflammation. Gels last 4 to 8 times longer than most normal eye drops.

Some of the newer versions of gel drops worth a try are:
1. GenTeal Eye Gel Carbopol 980 gel. This is the strongest gel drop. For flat out moisturization without blurriness.
2. Bausch and Lomb Liquid Gel Hypromellose gel.
3. Systane hydroxypropyl guar. This is the newest gel derivative and there is quite a bit of information on pubmed about the guaractions.

Many like the Similasan I and II drops. For those with severe dry eye, the Lacriserts placed under the eyelid at night still have no match.

Another good topical for ocular rosacea is an ointment called Lacrilubeby Allergan. It is kind of thick and sticky so you won't really be able to use it during the day. It definitely makes your eyes feel better, especially when they have that foreign body sensation or irritation. You put it directly in the pocket of your eyes.

If the inflammation is still severe, Doxycycline 100 mgs 2 to 4 times a day can be used or Periostat 40 mgs. If this fails, then the mast cell inhibitor Patanol is always a good try.

Two new eye drops/suspensions continue to show promise for moderate to severe ocular rosacea.
1. 10% N-acetylcysteine drops (Mucomyst) -- This mucolyticagent can be used successfully in rosacea patients with abnormal tear film layer (mucus layer). In ocular rosacea, the superficial inflammation can alter goblet cells, which affects the production of the tear film layer. This is the first agent to address this specific problem.

2. Cyclosporine ophthalmic (Restasis) drops -- Used to relieve dry eyes caused by suppressed tear production secondary to ocular inflammation. First eye drop to actually increase natural tear production, stabilize tear film layer and resolve ocular inflammation. Restasis eye drops are available by prescription. It can take up to 3 months to see their full effect.

Oral cyclosporine can cause a number of side effects. Topical cyclosporine (restasis) should be used cautiously in moderate to severe ocular rosacea patients, but it is generally much safer to use. Medical studies indicate it may be used safely long term 6 to 9 months with a low side effect profile. In many patients, it relieves the inflammation and therefore stops the tear film layer from breaking up.

Regarding rosacea, it specifically blocks several classes of inflammatory cytokines on the ocular surface, which this makes the ocular surface more "healthy". If you decide to start the eye drops, follow up with your doctor and get ocular surface testing every 3 to 6 months.

Ocular Rosacea And Allergies

Obviously, there is a great degree of overlap with eye symptoms from allergies. It is very wise to see an eye specialist. They will run a thorough series of tests to determine the most probable cause of your symptoms, and the physician should give you some effective treatment options.

Are Blue Eyes More Prone To Ocular Rosacea?

Are blue eyes more sensitive to irritation and sunlight? Probably not, according to Dr. Brian Pazzo, an ophthalmologist at NewYork-Presbyterian/Weill Cornell hospital."

First, as far as I know, color does not determine if the eyes become irritated easily," Pazzo said. "Some people with allergies, either ocular or full-body, tend to be very irritated by pollen, dust or dryness, and the irritation exists regardless of eye color."

As to the second question, Pazzo said, "In terms of light sensitivity, which is also called photophobia, light-colored eyes, like light-colored skin, have less of the pigment melanin and are probably more susceptible to the harmful effects of the sun, like certain types of eye cancer, but I know of no good long-term studies that demonstrate that blue eyes are more sensitive to light."Pazzo said that he had seen hundreds of cases of blepharitis, or inflammation of the eyelid, and rosacea, a skin irritation that can affect the eye area, and that from what he had observed, the irritation was more related to skin color than to eye color.

The iris is the colored part of the eye, while the pupil in the middle determines how much light gets to the back of the eyeball."

Oftentimes people with light-colored eyes have larger pupils," Pazzo said, but added, "In thousands of patients and colleagues, I have never seen reports that light-colored eyes are more sensitive to light."

Two Types of Blepharitis

Blepharitis is one of the most common problems of the eyes. It is inflammation of the margins of the eyelid. It often lasts for a long time and often recurs. It's inconvenient and unattractive but not usually destructive. Occasionally, however, it can cause loss of eyelashes and damage to the eye itself.
There are two types of blepharitis, anterior and posterior. Both are common.
Anterior blepharitis usually involves the eyelid, eyelashes and surrounding glands. It can be caused by a staph infection or seborrheic dermatitis of the scalp, brows or ears. Recent studies have found large numbers of a parasite called demodex in people with blepharitis. But the majority of people with this parasite do not have the condition.
Posterior blepharitis is an inflammation of the back of the eyelid, usually resulting from a problem with the sebaceous glands that secrete oil in the area. It is also associated with acne rosacea.
In addition to seborrhea and rosacea, other diseases that may cause blepharitis are lupus erythematosus, Sjogren's and Crohn's disease. It's important to look for symptoms of these diseases when evaluating someone with blepharitis.
Blepharitis stubbornly resists treatment. Available treatment often does not fully cure this condition but rather is directed at getting it under control and fighting flare-ups.
The main approach to treatment is twice-daily cleaning of the eyelids and application of warm compresses. Commercial eyelid scrubs are available and may be easier to use, but baby shampoo has been a mainstay of treatment for a long time.
Antibiotic ointments may be helpful when applied daily to the lid margins. If the eye surface itself becomes infected, oral antibiotics may be required. It is a good idea to sample the secretions on the eye to test for microorganisms and their sensitivity to antibiotics.
Topical steroids may help some people treat their blepharitis. But prolonged use of these medications may result in other eye problems. So, if steroids are used, it's important to discuss with the prescribing physician how often and how long to use them. Please discuss and write down the potential problems that may occur and what to do immediately if that happens.