Ocular Rosacea
The exact prevalence of ocular involvement in patients with Acne Rosacea is unknown, although it has been reported to be as low as 3 percent and as high as 58 percent. The disease may begin in the eye and escape diagnosis for a long time, even years, and be accompanied by inappropriate treatments. Ocular manifestations may develop prior to cutaneous manifestations in up to 20 percent of patients with Ocular Rosacea. Approximately half of these patients develop skin lesions first, and a minority develop both manifestations simultaneously. The Ocular complications are independent of the severity of facial rosacea. However, there is a strong correlation between the degree of eye involvement and tendency to flushing.
The Ocular signs are variable including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis The term Ocular rosacea (ophthalmorosacea) covers all these signs, also discourteously referred to as rabbit eyes.
Rosacea keratitis has an unfavorable prognosis, and in extreme cases can lead to blindness because of corneal opacity. The most frequent eye sign, which may never progress, is chronically inflamed margins of the eyelids, with scales and crusts, quite similar to seborrheic dermatitis, with which it is often confused. Pain and photophobia may be present. It is instructive to ask rosacea patients how their eyes react to bright sunlight. All patients with progressive rosacea should be seen by an ophthalmologist for a thorough examination to detect other subclinical complications. Indeed, such rosacea patients are ideally managed by the cooperative efforts of the dermatologist and the ophthalmologist.
Management of the Ocular disease requires both systemic and topical treatment, including lid hygiene, lubrication, and, occasionally, short-term topical corticosteroids.
what is Rosacea
Rosacea is a common chronic inflammatory disorder of the hair follicles, sebaceous glands and vasculature of the face. The role of Demodex mite in the pathogenesis of Rosacea is controversial.
Rosacea sufferers have recurrent flushing, exacerbated by heat (shower, hot drinks), spicy foods, sunlight, cold, alcohol, and stress. They have sensitive skin, and may complain of dry and gritty eyes.
The peak incidence of Rosacea is 30—50 yr; Females being more affected than Males.
Rosacea sufferers may develop erythema, telangiectases, papules, and pustules of central face; there are no comedones in contrast to acne. Sebaceous hyperplasia, seborrheic dermatitis and facial lymphedema are also more common.
There are 4 Major Subtypes of Rosacea:
Erythematotelangiectatic, papulopustular, ocular, and phymatous.
Chronic inflammation may progress to rhinophyma (enlarged nose; in males). Ocular involvement is also common (e.g., gritty, conjunctival injection, styes, photophobia).
Investigations include clinical diagnosis; uncommonly, skin biopsy is indicated to rule out lupus or sarcoidosis.
Similar conditions that needs to be differentiated from Rosacea are: Acne, lupus erythematosus, perioral dermatitis, sarcoidosis, seborrheic dermatitis.
Treatment of Rosacea is based on severity and subtype.
Lifestyle modification:
Avoid triggers; sun protection and avoidance; facial massage for lymphedema.
Topical antibiotics:
Metronidazole 0.75% gel or 1% cream bid.
Sodium sulfacetamide lotion 10% bid.
Oral antibiotics (moderate to severe cases with inflammatory papulopustular component):
Tetracycline 500 mg po bid
Minocycline 100 mg po od—bid.
Doxycycline 20 mg po bid (subantimicrobial dose therapy) or 100 mg po qd–bid.
Isotretinoin (low dose); less commonly, topical retinoids may be used.
Laser therapy (e.g., PDL, IPL) for telangiectases and ablative laser (e.g., CO2) for rhinophyma.
Camouflage makeup (e.g., Dermablend, Covermark) for erythema.
Ophthalmologist to assess for ocular Rosacea (blepharitis, conjunctivitis, episcleritis).
