Ocular rosacea often misinterpreted, treated with lifestyle changes
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Ocular rosacea may appear as other complications such as dry eye or blepharitis, and about 20% of patients will have ocular findings before dermatologic evidence of rosacea, according to a study published in the Journal of American Academy of Dermatology.
“Rosacea is a chronic inflammatory disorder of the facial skin that primarily affects the cheeks, nose, chin, forehead and eyes, often characterized by remissions and exacerbations,” Diane Thiboutot, MD, from Pennsylvania State University, and colleagues stated in the study. “Ocular manifestations occur in more than 50% of those with rosacea and may appear before or in the absence of cutaneous features.”
Thiboutot continued to explain that symptoms may include dryness, burning and stinging, light sensitivity, blurred vision and foreign body sensation, along with external signs of lid margin and conjunctival telangiectases, plugging of the meibomian glands and chalazia.
“In advanced disease, patients may present with chalazion affecting the eyelid,” they wrote. “Severe ocular rosacea may lead to corneal inflammation and scarring and, conceivably, corneal perforation with loss of visual acuity.”
The features of rosacea may be reduced or controlled with a range of topical and oral therapies or light devices along with appropriate skin care and lifestyle management. Additionally, oral antibiotics and retinoids are often used when first-line treatments for inflammation are inadequate in severe cases, although the researchers noted that published data on such treatments are sparse.
Recommended mainstays for treatment of ocular rosacea include eyelash hygiene and oral omega-3 supplements, followed by topical azithromycin and calcineurin inhibitors. Patients should also apply a warm compress and cleanse eyelashes twice daily with baby shampoo on a wet washcloth, they said.
“Recent studies have demonstrated topical azithromycin is equally as effective as oral doxycycline, with fewer adverse effects in the treatment of the ocular manifestations of rosacea,” Thiboutot and colleagues wrote. “For severe ocular rosacea, other oral medications may be prescribed by an [eye care provider]. Any corneal ulceration, inflammation or red eye should be immediately referred ... because it may result in reduced visual acuity.”
Because rosacea is characterized by flare-ups and remissions, the researchers advised that some rosacea exacerbations may appear to be initiated by environmental and lifestyle factors and that avoidance of those factors affecting the individual patient may help maintain remission.
“Clinicians may advise patients to keep a daily diary of lifestyle and environmental factors that appear to affect their rosacea to help identify and avoid their personal triggers,” they wrote.
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