Special care may be needed for rosacea patients with severe forms of ocular rosacea, according to Dr. Sandra Cremers, instructor of ophthalmology at Harvard Medical School. As part of a National Rosacea Society (NRS) research grant, she recently developed a scoring system to identify severe cases of this rosacea subtype, which may affect half of all rosacea patients.

The new questionnaire, called the Severity Criteria of Ocular Rosacea (SCOR), includes more than 25 signs and symptoms of ocular rosacea observed by both physician and patient, including eye dryness, tearing and burning; history of styes; inflammation; and potentially vision-threatening corneal involvement. The system was presented in a poster at the recent annual meeting of the American Academy of Ophthalmology.

Although ocular rosacea is often very mild, in an NRS survey of 1,780 rosacea patients reporting ocular symptoms, only 27 percent said they had been diagnosed with the condition, possibly indicating underdiagnosis.

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.

Dr. Cremers noted that for mild symptoms such as dry eye, a humidifier or other means to raise the humidity at home or in work environments as well as artificial tears may be appropriate.

In addition, washing the eyelashes daily with diluted baby shampoo on a warm wet washcloth may help keep the tear glands clear and unblocked. A hot compress can be placed on the eye for five minutes before the diluted baby shampoo is used to gently clean the eyelid margins. Then the face may be rinsed with closed eyes until the eyelashes feel clean and towel-dried. An eye doctor may also prescribe a cream for the lashes, Dr. Cremers said.

The researchers are now using the SCOR questionnaire to identify patients with severe ocular rosacea to evaluate the role of angiogenesis, which is the formation of new blood vessels in the disorder. Dr. Cremers noted that while new blood vessel growth is important for normal development and wound healing, this process is also implicated in some diseases.

Also, rosacea triggers such as sunlight have been linked to an increase in substances that may cause angiogenesis or inflammation, such as vascular endothelial growth factor (VEGF). Dr. Cremers and her group are currently investigating whether samples from severe cases of ocular rosacea contain any of these natural substances.