Soothing cleansing and other measures in addition to medical therapy may help relieve the symptoms of subtype 4 (ocular) rosacea, according to the standard management options for rosacea recently published by the National Rosacea Society (NRS).
"Gentle care in keeping eyelids clean is especially important in keeping eyes with ocular rosacea healthy," said Dr. Marian Macsai, professor of ophthalmology at the University of Chicago and a member of the consensus committee and review panel of 26 medical experts who developed the new standard options.1
Ocular rosacea is characterized by any one of many eye symptoms, including a watery or bloodshot appearance, foreign body sensation, burning or stinging, dryness, itching, light sensitivity and blurred vision.
Ocular symptoms may appear before or after the effects of rosacea on the skin, and in a recent NRS survey more than 60 percent of rosacea patients also reported eye involvement.
The meibomian glands, the oil glands inside the eyelids, are typically affected in ocular rosacea patients and may often be blocked. Blepharitis (inflammation of the eyelid) and the formation of collarettes (narrow circles of loosened keratin, the protein that makes up the outer layer of skin) around the base of the eyelashes are common. A gritty granular sensation indicates damage to the ocular surface.
Treatment of mild to moderate ocular rosacea may include artificial tears. Patients may apply a warm compress and cleanse the eyelashes twice daily with water or with baby shampoo on a wet washcloth. Antibiotic ointment may be prescribed to help decrease the presence of bacteria and soften any collarettes, and a low dose of oral antibiotic may be appropriate to reduce inflammation.
More severe cases should be examined by an eye specialist, who may prescribe a topical steroid, cyclosporine ophthalmic emulsion or oral medications, as potential corneal complications may involve the loss of visual acuity.
"If the symptoms of ocular rosacea persist, it's a good idea to make an appointment with an ophthalmologist," Dr. Macsai said. "Left untreated, patients with severe ocular rosacea could endure potentially serious consequences, such as scarring within the eyelid or corneal damage that could lead to decreased vision."
Reference
1. Odom R, Dahl M, Dover J, Draelos Z, Drake L, Macsai M, Powell F, Thiboutot D, Webster GF, Wilkin J. Standard management options for rosacea, part 2: options according to subtype. Cutis 2009;84:97-104.