A pair of new studies help establish the relative prevalence of signs and symptoms of the eyes of rosacea patients (ocular rosacea), as well as the importance of medical therapy.
“Although rosacea is generally thought of as a skin disease, research has shown that for the great majority of rosacea patients the eyes may also be affected,” said Dr. Mark Mannis, chair of ophthalmology at the University of California-Davis and a member of the National Rosacea Society’s medical advisory board. “In moderate to severe cases, treatment by an ophthalmologist may be especially necessary to prevent loss of visual acuity.”
Ocular rosacea signs and symptoms may include itching, burning and stinging; inflamed eyelids and styes (blepharitis); red or bloodshot eyes (conjunctivitis); the feeling that something is in the eye (foreign body sensation); and the development of visible blood vessels (telangiectasia) on the eyelids or whites of the eyes. In some patients the meibomian glands, which secrete an oil that helps tears keep the eye moistened, become clogged, causing tears to break down faster and leading to dry eye. As the condition worsens the cornea may become damaged, leading to reduced visual clarity.
A recent study published in International Ophthalmology aimed to identify which ocular signs and symptoms were most associated with rosacea, and the best methods for diagnosis.1 The researchers evaluated the right eyes of 76 rosacea patients and 113 people with no systemic or eye disorders. The examinations encompassed several methods, including use of a slit-lamp microscope (a common device used in most eye exams), technology known as optical coherence tomography (OCT)-assisted meibography to analyze meibomian gland function, and a standardized questionnaire about eye disease.
They found that foreign body sensation and itching were about twice as prevalent in rosacea patients than in the healthy control subjects (53.9% vs. 24.8% and 35.5% vs. 17.7%, respectively), dryness was more than four times as common (46.1% vs 10.6%), and meibomian gland dysfunction was about two-thirds more common (52.6% vs. 31%). However, conjunctival telangiectasia — blood vessels on the whites of the eyes — was found to occur overwhelmingly in the rosacea patients alone (26.3% vs 1.8%).
The researchers therefore recommended that eye doctors use detailed slit-lamp examinations to detect conjunctival telangiectasia, especially in cases of persistent dry eye symptoms. They also noted that OCT-assisted meibography may be important for identifying and evaluating meibomian gland dysfunction.
A recent study in Argentina illustrated the importance of treating ocular rosacea promptly.2 The eyes of 51 rosacea patients were examined by researchers, and 38 (74.5%) had signs of eye involvement. Of these, all had erythema and telangiectasia on the eyelid margin, and all but one had meibomian gland dysfunction. Fifteen suffered decreased visual acuity due to rosacea-related complications, including scarring and blood vessels on the cornea.
“We found a significant association between the severity of ocular findings, assessed as a diminished visual acuity due to rosacea corneal involvement,”and the presence of rosacea symptoms of the skin, including excess tissue (rhinophyma) and bumps and pimples (papules and pustules), the investigators reported.
The most common therapies given to the ocular rosacea patients in the study were artificial tears, oral doxycycline, corticosteroid-antibiotic ointment and a lid hygiene regimen. However, three patients required corneal transplants to restore their vision. The researchers recommended that special attention be paid to worsening eye symptoms during flare-ups of rosacea on the skin, and that patients should be referred to an ophthalmologist for treatment when vision is threatened.
1. Ozturk T, Kayabasi M, Ozbagcivan O, Ayhan Z, Utine CA. Common ocular findings in patients with acne rosacea. Int Ophthalmol 2021 Nov 2. Epub ahead of print.
2. Saá FL, Cremona F, Chiaradia P. Association between skin findings and ocular signs in rosacea. Turk J Ophthalmol 2021 Dec 28;51(6):338-343.