While avoidance of trigger factors, gentle cleansing and a variety of medical therapies are among today’s options for controlling ocular rosacea, continuing research on its pathophysiology is uncovering potential avenues for the development of important new advances in its treatment, according to Dr. Edward Wladis, associate professor and vice-chairman of ophthalmology at Albany Medical College, in a recent article in the medical journal Survey of Ophthalmology.1
“While ocular rosacea remains incurable, exciting new research may lead to a variety of potential targets for innovative therapy that may interfere with the disease process,” Dr. Wladis said. “The processes involved in the body’s response to rosacea appear to be related to inflammation – the complex biological response of body tissues to harmful stimuli.”
Fortunately, he added, several recent studies have enhanced understanding of the biology of ocular rosacea in a way that may point to new medical options.
Though rosacea may affect the eyes, skin analysis may yield information that is pertinent to ocular rosacea patients as well. In a study of a variety of molecules in skin biopsies from individuals with ocular rosacea, Dr. Wladis and colleagues reported that certain molecules appeared in significantly different concentrations than in those with rosacea not involving the eyes, and these may be important targets for therapy. Such molecules included cytokines, chemokines and angiogenic factors.
The presence of greater colonization of the skin by bacteria or other microorganisms, including Demodex mites, has long been recognized as a possible contributor to rosacea. In another study, Dr. Wladis and colleagues investigated the body’s possible response to this colonization by measuring certain substances produced by the body’s innate immune system to fight invasive organisms, and found protein elevations that may be related to vascular abnormalities found in ocular rosacea. Interfering with this process, he noted, may be helpful in managing the eye symptoms.
The article noted that available medical treatments are often ineffective, allowing the disorder to continue to have a significant impact on the vision, comfort and socioeconomic ability of its sufferers. Because current medical approaches fail to address the disease’s underlying causes, Dr. Wladis said, they may also serve to conceal underlying cellular and molecular changes.
Lifestyle modification continues to be a key measure in the management of ocular rosacea, and avoidance of rosacea triggers – environmental or emotional factors that cause a rosacea flare-up – is a standard of care. Rosacea tripwires vary among patients, and commonly include sun exposure, extreme weather, alcohol, spicy foods, heated beverages and physical or emotional stress. It’s also important to shield the eyes with UV-protected glasses or sunglasses.
Gentle cleansing is also often recommended. Warm compresses and eyelid scrubs may remove debris and keep the tear glands open, and massage of the oil glands around the eye may help as well. Baby shampoo may also bring some improvement, Dr. Wladis added.
Artificial tears have been used to counteract the ocular surface dryness caused when the meibomian gland is blocked. He noted that blepharitis, or dry eye, may also be relieved by fish oil and flax seed supplementation.
A variety of prescription topical and oral therapies may produce beneficial effects, he said, as well as light therapies, including intense pulsed light and laser therapy. Surgery may also be required to relieve certain symptoms such as drainage of blocked oil glands.
Wladis EJ, Adam AP. Treatment of ocular rosacea. Surv Ophthalmol 2017 Aug 3. pii: S0039-6257(17)30001-2. doi: 10.1016/j.survophthal.2017.07.005. [Epub ahead of print]