Ocular Rosacea

2011-10-06T07:54:00.000-07:00

Ocular rosacea is an inflammatory eye condition often associated with the skin condition rosacea. Ocular rosacea can cause a persistent burning or gritty feeling in the eyes of the rosacea patient with resulting eye redness. For others, it can manifests itself as inflamed and swollen eyelids with small inflamed bumps, eye lashes that may fall out, compounded by bloodshot eyes. The most frequent symptoms, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts, quite similar to seborrheic dermatitis, with which ocular rosacea is often confused. Pain and photophobia (abnormal sensitivity to light) may be present. The ocular complications are independent of the severity of facial rosacea.

Treating Ocular Rosacea Symptoms

2010-10-11T07:56:00.000-07:00

Many rosacea sufferers develop the ocular form of rosacea in addition to facial symptoms. Fortunately, the effects of ocular rosacea can be successfully controlled with proper care.

Ocular rosacea symptoms may appear as simply a watery or bloodshot appearance in the eyes. Some patients may feel as though there is something in their eyes, or have a dry, burning or stinging sensation. In severe cases, ocular rosacea may include swollen blood vessels; inflammation of the eyelid, iris or the whites of the eyes; sties or cysts, and in severe cases even loss of vision.

A number of steps can be taken to help soothe the eyes and prevent irritation and discomfort:
1)Clean carefully the area surrounding the eye. Just as with a facial rosacea care routine, daily eye care starts with removing all eye makeup, using a gentle, non-abrasive cleanser and rinsing with lukewarm water several times to make sure the eye area is completely clean. Blot dry gently with a soft cotton towel. After the eye area air-dries for a few moments, use a gentle moisturizer such as jojoba oil on the lids and underneath the eyes.

2) If eye dryness or a gritty feeling is a problem, you may benefit from using a special agent to moisten the eyes. Preservative-free artificial tears applied several times a day can help eliminate that dry, gritty feeling.

3) Apply warm compresses and gently massage the eyelids. Not only will this feel refreshing, but massaging the eyelids will help loosen any debris in the tear glands and stimulate circulation. This can be especially soothing after a long day at work, or being outside in the cold and wind.

4) Wear UV sunglasses outdoors. They protect your eyes from harmful rays of the sun, and act as a shield against wind and other elements. Sunglasses without UV protection may actually make the condition worse.

5) Increase you water intake. The eye is over 90% water and a lack of adequate water intake will result in dry, red and irritated eyes.

Ocular Rosacea Symptoms

2010-08-30T09:05:00.000-07:00

Ocular Rosacea is an inflammatory eye condition which can cause a persistent burning or gritty feeling in the eyes. Ocular rosacea may also manifest as inflamed and swollen eyelids with small inflamed bumps, eyelashes that may fall out, compounded by bloodshot eyes. The ocular complications are independent of the severity of facial rosacea. It is reported that 50 to 60% of all rosacea sufferers also have some sort of symptoms with their eyes which is known as ocular rosacea.

In severe ocular rosacea, there may be corneal ulceration (infection) which, if untreated, may even lead to perforation of the eye. People with ocular rosacea symptoms have a tendency to be more dehydrated than others. The body is approximately 65% water while the eye is 96% water. Increasing your water intake will increase the moisture in the eye (thereby decreasing irritation and dryness). It has been found that increasing the amount of water consumed daily can ease the symptoms of ocular rosacea for many.

The Occurrence of Styes in Ocular Rosacea

2010-06-21T09:15:00.000-07:00

Sties may be present in ocular rosacea. Styes, sties or simply spelled “sty”, is a bacterial based pimple caused by Staphylococcus aureus, which is a type bacteria commonly found in the human nose. Sties may also be the result of a clogged pore or hair follicle. Styes are often mistaken for chalazions. Styes can be painful and are the approximate size of a regular acne pimple.

The best treatment for a sty is a warm compress. Apply a warm, moist washcloth to your lids for 5 minutes, four times a day. Within a few days the infection will either die down or come to a head and drain.

Other ocular complications of rosacea include blepharitis, keratitis, conjunctivitis, iritis, Iridocyclitis, Hypopyoniritis, Chalazian and dry eye syndrome. The ocular complications of rosacea are independent of the severity of facial rosacea. The most frequent signs, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts. Ocular rosacea varies from patient to patient just as facial rosacea varies with no two patients being exactly alike in intensity or degree of loss of sight. Ocular rosacea can cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small-inflamed bumps. The eyes may become bloodshot and eyelashes sometimes fall out.

Treatment of ocular rosacea and styes, require a highly motivated patient. A dermatologist treats the direct impact of rosacea on the skin but is not trained in the treatment of rosacea involving the eyes. An ophthalmologist specializes in the treatment of eye conditions does not always link this to a co-coordinating treatment for rosacea manifestations of the skin. Many ophthalmologists feel that treating ocular rosacea conditions with antibiotics produce the same results in the same amount of time as not treating the ocular symptoms at all. For this reason there is a growing trend not to treat ocular conditions with medication but to simply let it run its course.

What is Ocular Rosacea

2010-05-28T10:50:00.000-07:00

The ophthalmic signs of ocular rosacea can vary widely, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ophthalmic or ocular rosacea covers all these signs.

50 to 60% of all rosacea sufferers also have ocular rosacea. Approximately 20 percent of ocular rosacea problems occur prior to the typical skin related rosacea symptoms though it is more normal for the skin symptoms to appear first.

Ocular rosacea can cause a persistent burning or gritty feeling in the eyes. For others, ocular rosacea manifests itself as inflamed and swollen eyelids with small-inflamed bumps, eyelashes that may fall out, c ompounded by bloodshot eyes. The most frequent signs, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts; quite similar to seborrheic dermatitis, with which ocular rosacea is often confused.

Pain and abnormal sensitivity to light may be present. The ocular complications are independent of the severity of facial rosacea.

Treating Ocular Rosacea

2010-04-28T12:03:00.000-07:00

Treatment of ocular rosacea usually consists of lid hygiene measures, such as daily cleansing with cotton-tipped applicators (Q-tips). This entails cleansing the bases of the lashes with a moistened Q-tip to remove debris and oily secretions. Some ophthalmologists advocate cleansing with diluted baby shampoo, while others believe that plain water is best. Often, an antibiotic or combination antibiotic-steroid ointment is prescribed for various periods of time, depending on response.

Ocular rosacea is not dangerous, but in rare cases it can travel to the cornea causing infections and problems with the inner blood vessels. Keeping eye drops on hand for the sensation of dry eyes is extremely helpful, but consultations with medical professionals who are well familiarized with ocular rosacea are critical. When ocular rosacea flare-ups occur, a warm washcloth across the eyes can help reduce the pain of inflammation or from styes. Doctors may prescribe oral antibiotics to treat the infected oil gland. Often, using eye drops to alleviate the itchy or dry sensation helps and then the warm compress and antibiotics will take care of the other symptoms of ocular rosacea.

The most important thing for any person with rosacea to do is to try to prevent the rosacea from becoming severe. There is no cure for rosacea, but with proper skin care and diet, the flare-ups can be reduced in severity and frequency. If the rosacea on your cheeks, chin, and nose are reduced, then it is far less common for the condition to spread to the eyes

Rosacea Ltd For The Treatment Of Ocular Rosacea

2010-03-04T10:00:00.000-08:00

Ocular rosacea is defined as an inflammatory eye condition often associated with the skin condition acne rosacea. Ocular rosacea can cause a persistent burning or gritty feeling in the eyes. For others, ocular rosacea manifests itself as inflamed and swollen eyelids with small inflamed bumps, eye lashes that may fall out, compounded by bloodshot eyes. The ophthalmic symptoms of ocular rosacea can vary widely, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ophthalmic or ocular rosacea covers all these symptoms. The most frequent symptoms, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts, quite similar to seborrheic dermatitis, with which ocular rosacea is often confused. Pain and photophobia (abnormal sensitivity to light) may be present. The ocular complications are independent of the severity of facial rosacea.

Rosacea-Ltd III is designed for use for ocular rosacea as the application to the closed eye lids for one second is easy with the ingredients penetrating the eyelids. During the past 12 years, 98% of Rosacea-Ltd customers confirm that they are extremely impressed.

The International Rosacea Foundation Explains Keratitis in Ocular Rosacea

2009-11-17T09:21:00.000-08:00

Keratitis is one of the more serious conditions of ocular rosacea, which may occur in relation to ocular rosacea. Keratitis is a term used to cover a range of ocular conditions where there is infection or inflammation of the cornea. This condition may result in severe eye pain, blurry vision and sensitivity to light. Medical evaluation and treatment of keratitis is absolutely essential. Minor corneal infections are commonly treated with anti-bacterial or anti-fungal eye drops. If the problem is more severe, a person may receive more intensive antibiotic treatment to eliminate the infection and may even require steroid eye drops to reduce inflammation.

Treatment of ocular rosacea requires a highly motivated patient. With regard to ocular rosacea, treatment usually consists of lid hygiene measures, such as daily cleansing with cotton-tipped applicators (Q-tips). This entails cleansing the bases of the lashes with a moistened Q-tip to remove debris and oily secretions. Some ophthalmologists advocate cleansing with diluted baby shampoo, while others believe that plain water is best. Often, an antibiotic or combination antibiotic-steroid ointment is prescribed for various periods of time, depending on response.

Ocular rosacea is not dangerous, but in rare cases it can travel to the cornea causing infections and problems with the inner blood vessels. Keeping eye drops on hand for the sensation of dry eyes is extremely helpful, but consultations with medical professionals who are well familiarized with ocular rosacea are critical. When ocular rosacea flare-ups occur, a warm washcloth across the eyes can help reduce the pain of inflammation or from styes. Doctors may prescribe oral antibiotics to treat the infected oil gland. Often, using eye drops to alleviate the itchy or dry sensation helps and then the warm compress and antibiotics will take care of the other symptoms of ocular rosacea.

The most important thing for any person with rosacea to do is to try to prevent the rosacea from becoming severe. There is no cure for rosacea, but with proper skin care and diet, the flare-ups can be reduced in severity and frequency. If the rosacea on your cheeks, chin, and nose are reduced, then it is far less common for the condition to spread to the eyes.

Rosacea-Ltd Defines the Ocular Condition Blepharitis

2009-10-29T09:47:00.000-07:00

Blepharitis is a common inflammatory ocular condition that affects the eyelids. It usually causes symptoms including burning, itching, and irritation of the lids. Other common symptoms include sandy, itchy eyes, red and/or swollen eyelids, crusty, flaky skin on the eyelids, and dandruff. In severe cases, this ocular condition may also cause sties, irritation, and inflammation of the cornea (keratitis) and conjunctiva (conjunctivitis). Some patients have no ocular symptoms at all. Blepharitis, usually a chronic problem, can be controlled with extra attention to lid hygiene. However, it may also be caused by an infection which would require treatment with a prescription medication. The key to controlling blepharitis is to keep the eyelids and eye lashes clean. Remember to practice preventative treatment and remove all mascara and make-up before going to bed.

Types of Ocular Rosacea - The Dry Eye Syndrome

2009-10-22T08:34:00.000-07:00

The dry eye syndrome, which often accompanies ocular rosacea, can also be treated with non-preserved artificial tears, as often as 4 times a day or more. Another ocular treatment is a home humidifier, which may also add valuable moisture to the air. If these treatments for the symptoms of ocular rosacea are not sufficient, more drastic treatments may be needed. One such ocular treatment involves closure of the tear drainage ducts, which is accomplished with silicone plugs, which are reversible, or punctal cautery (a burning of the tear duct openings), which is a relatively permanent ocular treatment.

The ophthalmic symptoms of rosacea are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The rosacea ophthalmic complications are independent of the severity of facial rosacea. The most frequent symptom of ocular rosacea or opthalmic rosacea are chronically red margins of the eyelids with scales and crusts. Pain and photophobia (abnormal sensitivity to light) may be present. The ocular complications are independent of the severity of facial rosacea

Ocular Rosacea Statistics

2009-10-16T08:45:00.000-07:00

50 to 60 % of facial rosacea sufferers report having ocular rosacea.
Up to 20% of people may only present with symptoms of ocular rosacea leading to some confusion and delay in treatment.

In one study of Drs. Starr and McDonald in 1969, they reported that ocular rosacea symptoms occurred in 58% of patients. Ocular rosacea is a condition in which the facial redness of rosacea travels to the eyelids and in some cases the inner eye area itself. Patients with ocular rosacea most commonly experience irritation of the lids and eye, occurring when the oil-producing glands of the lids become obstructed. Signs and symptoms of ocular rosacea can include chronically red eyes and lid margins, irritated eyelids (blepharitis), styes (chalazion), dry, irritated eyes, burning, and the sensation of a foreign body in the eye. Ocular rosacea may also affect the cornea, causing neovascularization (abnormal blood vessel growth), infections, and occasionally ulcers.

Ocular rosacea patients generally have chronically "bloodshot" eyes, dry eyes, and blepharitis (inflammation and debris of the eyelid margins). In severe ocular rosacea, there may be corneal ulceration (infection), which, if untreated, may even lead to perforation of the eye. This can be a potentially blinding complication.

Rosacea's Effect On The Eyes

2008-06-23T11:25:00.000-07:00

Rosacea can cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small inflamed bumps, eye lashes sometimes fall out, compounded by bloodshot eyes. The ocular signs of rosacea are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ocular rosacea covers all these signs. The ocular complications are independent of the severity of facial rosacea. Keratitis has an unfavorable prognosis, and in extreme cases can lead to corneal opacity with blindness. The most frequent sign of ocular rosacea, 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.

Treatment of Ocular Rosacea

2008-03-14T09:59:00.000-07:00

Ocular rosacea as it relates to rosacea can be as varied as the variance in severity and intensity of rosacea from one person to the next. Ocular Rosacea is described as an inflammatory eye condition often associated with acne rosacea. Ocular rosacea can cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small-inflamed bumps. The eyes may become bloodshot and eyelashes sometimes fall out (Dr. Thiboutot). The ophthalmic signs of rosacea are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. (These conditions will be described in detail below.) The term ophthalmic rosacea covers all these signs. The rosacea ophthalmic complications are independent of the severity of facial rosacea. The most frequent signs, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts; quite similar to seborrheic dermatitis, with which ocular rosacea is often confused. Pain and photophobia (abnormal sensitivity to light) may be present. For this reason, a rosacea sufferer needs to consider how their eyes react to bright sunlight, as the eyes are very sensitive to sunlight. The ocular complications are independent of the severity of facial rosacea (Drs. Gerd Plewig & Albert M. Kligman). Rosacea keratitis has an unfavorable prognosis, and in extreme cases can lead to corneal opacity with blindness. Ocular rosacea combined with Keratitis could lead to blindness.

Statistics show that more than fourteen million people suffer from some form of rosacea, be it mild or severe. Approximately 60% of patients with rosacea develop related problems affecting the eye (ocular rosacea). Ocular rosacea is a condition in which the facial redness of rosacea travels to the eyelids and in some cases the inner eye area itself. In one study (Starr, McDonald 1969) it was found that ocular rosacea symptoms occurred in 58% of patients. Patients with ocular rosacea most commonly experience irritation of the lids and eye, occurring when the oil-producing glands of the lids become obstructed. Signs and symptoms of ocular rosacea can include chronically red eyes and lid margins, irritated eyelids (blepharitis), styes (chalazion), dry, irritated eyes, burning, and the sensation of a foreign body in the eye. Ocular rosacea may also affect the cornea, causing neovascularization (abnormal blood vessel growth), infections, and occasionally ulcers.

Those with ocular rosacea are frequently frustrated with their chronic eye condition. It is reported that 50 to 60% of all rosacea sufferers also have ocular rosacea. In one study (Starr, McDonald 1969) it was found that ocular rosacea symptoms occurred in 58% of patients. One treatment that has been shown to be effective in treating ocular rosacea is Rosacea-Ltd III.

Treating Ocular Rosacea

2007-02-14T10:24:00.000-08:00

Treatment of ocular rosacea requires a highly motivated patient. With regard to ocular rosacea, treatment usually consists of lid hygiene measures, such as daily cleansing with cotton-tipped applicators (Q-tips). This entails cleansing the bases of the lashes with a moistened Q-tip to remove debris and oily secretions. Some ophthalmologists advocate cleansing with diluted baby shampoo, while others believe that plain water is best. Often, an antibiotic or combination antibiotic-steroid ointment is prescribed for various periods of time, depending on response.
We also have found it beneficial to include in your diet three servings per week from the Omega-3 supplements. These essential fatty supplements aid in an overall balanced diet as well as easing the discomfort of ocular rosacea.
Antibiotics from the tetracycline family such as Doxycycline and Minocycline are often prescribed to bring symptoms of ocular rosacea under control. Studies of the use of Doxycycline by patients with ocular rosacea showed significant improvement with a variety of signs/symptoms including dryness, itching, blurred vision and photosensitivity, scales, erythema and telangiectasis (Quarterman 1997)
For dry eyes, some rosacea sufferers use Celluvisc Eye treatment drops found at drug stores or grocery stores. They are much thicker than the usual eye drops and can be used without taking out contact lenses. Because of the thickness of the eye drops, they may temporarily impair vision.
Those with ocular rosacea are frequently frustrated with their chronic eye condition.

How Common Is Ocular Rosacea?

2007-02-07T11:17:00.000-08:00

It is reported that 50 to 60% of all rosacea sufferers also have some sort of symptoms with their eyes which is known as ocular rosacea. In one study (Starr, McDonald 1969) it was found that ocular rosacea symptoms occurred in 58% of patients.
Sometimes (perhaps 20% of the time) ocular rosacea problems occur prior to the typical skin related rosacea symptoms though it is more usual (about 53% of the time) for the skin symptoms to appear first. (Borrie, 1953).
Ocular rosacea patients generally have chronically "bloodshot" eyes, dry eyes, and blepharitis (inflammation and debris of the eyelid margins). In severe ocular rosacea, there may be corneal ulceration (infection) which, if untreated, may even lead to perforation of the eye. This can be a potentially blinding complication.
People with rosacea have a tendency to be overall more dehydrated than others. The body is approximately 65% water while the eye is 96% water. Increasing your water intake will increase the moisture in the eye (thereby decreasing irritation and dryness). It has been found that increasing the amount of water consumed daily can ease the symptoms of ocular rosacea for many.

Perioral-nasal-ocular dermatitis

2007-01-04T11:36:00.000-08:00

Perioral-nasal-ocular dermatitis a type of dermatitis that occurs only around the mouth, nose and eyes. It does not have to be present in all of the areas at the same time. Some people believe that Perioral-nasal-ocular dermatitis does in fact not exist and that people that fit the clinical picture of Peri-ral-nasal-ocular dermatitis are in fact suffering from Rosacea.
It is certainly true that Rosacea and Perioral-nasal-ocular dermatitis can at times seemingly be present in the same patient. Because it is always more likely that someone is suffering from 1 condition rather than 2 conditions at the same time, the abovementioned phenomenon lends support to the thesis that Rosacea and Perioral-nasal-ocular dermatitis is the same condition with 2 slightly different clinical expressions. Histologically, i.e. when looking at a piece of skin under the microscope that has been obtained by biopsy from a patients face, both Rosacea and Perioral-nasal-ocular dermatitis displays the same type of inflammation, knows as a granulomatous peri-folliculitis. The word granulomatous refers to a collection of macrophages (a type of white blood cell). Peri-folliculitis means that the "collection of macrophages" is lying in close proximity to a hair follicle.
Whether or not Rosacea and Perioral-nasal-ocular dermatitis is the same disease or two separate diseases, might be a question that is more important from an academic viewpoint than from the patients viewpoint. The fact is that the clinical picture known as Perioral-nasal-ocular dermatitis is quite classic and most often easily recognizable and treatable.
Classically young female patients are affected. The rash consists of small red bumps (knows as papules) and occasionally small pimples (knows a pustules) occurring around the mouth, nose and eyes. Interestingly, a small margin of skin around the edge of the lips are always unaffected. As mentioned before not all 3 of these areas has to be affected at the same time.
More than 80% of patients with Perioral-nasal-ocular dermatitis have been applying corticosteroid-containing creams to the face, before the rash started to appear. In the remaining cases the cause is unclear, but the excessive use of facial cosmetics seems to be another common factor.
The treatment of this condition involved the stopping of all (if possible) topical creams and lotions that the patient are using. If topical corticosteroid-containing creams have been used they should be tapered off slowly and not stopped suddenly, because this will lead to a flare-up of the condition.
The treatment of Perioral-nasal-ocular dermatitis involves the use of oral tetracycline antibiotics for a few months. Sometimes this is combined with antibiotic creams, but in general it is better to avoid as many creams as possible. Most often this approach results in complete clearance of the skin condition in a few weeks.

Information On Ocular Rosacea

2006-12-11T11:37:00.000-08:00

Learn More About Ocular Rosacea:
Eye and Skin Disease by Mannis, Macsai, and Huntley, ch 41. A very detailed medical coverage of Rosacea including a very comprehensive discussion of Ocular Rosacea.
Ocular Rosacea : American Family Physician
Keratitis on Spedex.Com.
More Keratitis information from the University of Michigan.
Iritis Information on Iritis.Org
Blepharitis Information from Merck and from Cecille G. Taylor MD
Episcleritis description
Article about chalazia
Ocular Symptoms of Rosacea

Ocular Side Effects From Accutane

2006-11-02T11:21:00.000-08:00

A new study confirms and ranks ocular adverse events associated with isotretinoin, providing dermatologists and other clinicians with guidelines for ocular exams, according to Frederick W. Fraunfelder and research colleagues with the Casey Eye Institute, Oregon Health Sciences University.
"We want to help clinicians make an informed decision as to whether the side effects reported by patients are real," said Dr. Fraunfelder, assistant professor of ophthalmology, Casey Eye Institute. For example, some patients may complain of double vision, which is classified in this study as unlikely and may not be drug induced.
In the September 2001 edition of the American Journal of Ophthalmology, the researchers describe 38 different signs and symptoms considered ocular abnormalities associated with isotretinoin.
Isotretinoin is indicated for severe recalcitrant nodule acne that has failed to respond to conventional therapy, including systemic antibiotics. It is strictly prohibited for pregnant women or those who may become pregnant because of the risk of major human fetal deformities.
Making the list
According to Dr. Fraunfelder, side effects considered certain include decreased dark adaptation, decreased vision, ocular sicca, (dry eye), abnormal meibomian gland secretion, meibomian gland atrophy, blepharoconjunctivitis (inflammation of the eyelid), corneal opacities (only visible with a microscope), keratitis (corneal inflammation), decreased tolerance to contact lens, increase tear osmolarity, photophobia, myopia (near sightedness), ocular discomfort, as well as teratogenic ocular abnormalities.
Those on the probable/likely list include reversible decreased color vision and permanent loss of dark adaptation. Permanent keratoconjunctivitis sicca has a possible association with the drug.
"I would say the most serious would be anything that causes vision loss," Dr. Fraunfelder said. "Dermatologists need to ask patients on isotretinoin to talk about vision loss or dark adaptation problems. Does it take a long time for their eyes to adjust from sunlight when driving into a tunnel? It tells the dermatologist to refer to an ophthalmologist for more formal testing.
Package insert adverse events, which occurred in 80 percent of patients taking isotretinoin, include dry skin, skin fragility, pruritis, epistaxis, dry nose, and dry mouth. Up to 90 percent of patients in clinical trials reported cheilitis and 40 percent with conjunctivitis.
How they were graded
To establish a cause and effect relationship between the drug and side effects and then determine its classification, Dr. Fraunfelder and colleagues used the World Health Organization Causality Assessment Guide of Suspected Adverse Reactions criteria. To be labeled as a certain reaction, the side effect had to provide positive re-challenge data in several cases. "De-challenge data is when you stop the drug and the side effect goes away. But if you restart the drug and the side effect returns, that's a positive re-challenge and convincing evidence of an adverse drug event," he explained.
They are classified as certain, probably/likely, possible, unlikely or conditional/unclassifiable. The data is derived from 1,741 case reports received from various reporting systems, including the Food and Drug Administration, World Health Organization, the drug safety section of Roche Pharmaceuticals, and the National Registry of Drug-Induced Ocular Side Effects (based at the Casey Eye Institute).
"I think working closely with an ophthalmologist will help determine if isotretinoin should be continued," said Dr. Fraunfelder. "The dermatologist who is really well read in the area can look for more than 'the big three,'" which include problems with dark adaptation, color vision, and dry eye.
"I think dermatologists are aware of the (ocular) side effects from isotretinoin," he added. "It is known to cause dry eye and some photosensitivity. Many are probably aware that it could cause some vision changes, but it has never been reported until this journal article that there are certain associations."
Other considerations
Another recent study by the FDA supports previous data suggesting that serious clinical depression may result from taking isotretinoin.
The 18-year study is published in the October 2001 Journal of the American Academy of Dermatology. In 18 years, from 1982 to 2000, the FDA has records of 431 patients taking the drug who also developed depression-related complications. Some committed suicide (37); others were hospitalized for depression, suicide ideation or attempt (110), or suffered nonhospitalized depression (284). "Compared with all drugs in the FDA's Adverse Event Reporting System database to June 2000, isotretinoin ranked within the top 10 for number of reports of depression and suicide attempt," the researchers concluded.
They also advise physicians to inform patients and their families to watch for signs of depression or worsening of depression. Reports about mood swings, loss of appetite, unusual fatigue, withdrawal, inability to concentrate, and other symptoms of depression should be addressed immediately, "including consideration of drug discontinuation and referral for psychiatric care."

For more information
Fraunfelder FT, Fraunfelder FW, Edwards R. Ocular side effects possibly associated with isotretinoin use. Am J Ophthalmol 2001 Sep;132(3):299-305.
www.ohsucasey.com (education links to National Registry)
Wysowski DK, Pitts M, Beitz J. An analysis of reports of depression and suicide in patients treated with isotretinoin. J Am Acad Dermatol 2001 Oct;54(4):515-519.

The Eyes Of Rosacea

2006-10-31T09:34:00.000-08:00

Ocular Rosacea is an inflammatory eye condition often associated with rosacea. Ocular rosacea can cause a persistent burning or gritty feeling in the eyes. Ocular rosacea may also manifest itself as inflamed and swollen eyelids with small inflamed bumps, eyelashes that may fall out, compounded by bloodshot eyes (Dr. Thiboutot). The ophthalmic signs of ocular rosacea can vary widely, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ophthalmic or ocular rosacea covers all these signs. The most frequent signs, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts; quite similar to seborrheic dermatitis, with which ocular rosacea is often confused. Pain and light sensitivity may also be present. The ocular complications of rosacea are independent of the severity of facial rosacea (Drs. Gerd Plewig & Albert M. Kligman).

Ocular Rosacea Defined By The American Academy of Ophthalmology

2006-10-18T10:22:00.000-07:00

Rosacea (pronounced rose-AY-shah) is a chronic disease that affects both the skin and the eyelids.
People with rosacea affecting their skin may flush easily and have redness and/or acne-like symptoms on their nose, cheeks, chin or forehead.
People who have ocular rosacea (involving the eye) may have:
Red or bloodshot eyes
Burning or tearing
Sensation of foreign material or sand in the eye An infection (not contagious) of the eyelids also can occur and may cause redness and swelling on the lids and at the base of the eyelashes.
More than half of people with rosacea affecting their skin have some symptoms of ocular rosacea. However, some people may have ocular rosacea without showing any skin symptoms.
Approximately 13 million people in the United States have rosacea. It usually occurs in adults (especially women) between the ages of 30 and 60. Although people of any skin color can develop rosacea, it tends to occur most frequently in people with fair skin.
What Causes Rosacea?
Scientists do not know what causes rosacea, but some think that genetics and environment may play a role in its development. Some researchers believe that rosacea is a disorder that involves swelling of the blood vessels, resulting in flushing and redness. Other scientists think that a microscopic organism or mite in tiny facial hair follicles may clog the skin's oil gland openings, causing swelling and redness. Some research also has shown a possible link between rosacea and the bacteria called Helicobacter pylori — the same bacteria that cause gastrointestinal infections.
Several factors are known to aggravate (but not cause) rosacea, including:
Exposure to heat, sunlight, wind and cold
Strenuous physical activity
Drinking alcohol
Consuming hot drinks or spicy foods
Experiencing emotional stress
Coughing for long periods How Is Rosacea Treated?
Rosacea cannot be cured, but it can be treated and controlled. For skin symptoms, doctors usually prescribe either a topical antibiotic (which is applied directly to the skin) or, in more severe cases, an oral antibiotic (taken by mouth). Ocular symptoms usually are treated with oral antibiotics, such as tetracycline or doxycycline, or with prescription eyedrops or ointments containing steroids. Artificial tear-type saline solutions can help to relieve some of the symptoms of ocular rosacea by keeping eyes well moisturized. Some people, however, should avoid using eyedrops specifically meant for clearing up bloodshot eyes, as these eventually can make ocular rosacea symptoms worse.
Doctors recommend that people who develop eyelid infections with rosacea should practice good lid hygiene regularly. Patients should scrub their eyelids very gently with baby shampoo mixed with water or use a recommended eyelid-cleaning product. They also should apply warm cloths or pads to their eyes several times a day.
Ocular rosacea, on occasion, may affect eyesight if it is left untreated. Once ocular rosacea is treated and controlled, a patient's condition generally improves.

© July 2004 American Academy of Ophthalmology

Antibiotic Treats Lymphoma Of The Eye

2006-10-11T11:35:00.000-07:00

The common antibiotic doxycycline effectively treats a type of lymphoma associated with chlamydia infection, according to a study in the October 4 issue of the Journal of the National Cancer Institute.
Ocular adnexal lymphoma of the MALT-type (OAL) is a kind of cancer of the eyelids and related tissues. It is not often fatal, but its symptoms can compromise a patient's quality of life. Some research has suggested an association between OAL and infection with the bacteria Chlamydia psittaci.
Andres J. M. Ferreri, M.D., of the San Raffaele H Scientific Institute in Milan, Italy, and colleagues examined whether doxycycline was an effective treatment for OAL. They gave 27 OAL patients a 3-week course of doxycycline therapy, whether they were positive or negative for chlamydia. They looked for tumor progression every 6 months.
The authors found that doxycycline treatment caused lymphoma to regress in both patients who did not test positive for the disease and those who did. They suggest that doxycycline may be a useful therapy even in patients where other treatments have failed, and it is a valid alternative to chemotherapy and radiation without causing the same toxic side-effects. Patients treated with doxycycline had a 66% rate of disease-free survival.
"Our prospective trial revealed that doxycycline is a fast, safe, and active treatment for OAL, both at initial diagnosis and at relapse," the authors write.
In an accompanying editorial, Emanuel Zucca, M.D., and Francesco Bertoni, M.D., of the Oncology Institute of Southern Switzerland, write, "While doxycycline appears to be an easy-to-implement therapeutic approach, we strongly encourage all physicians to enroll patients in clinical prospective trials to help answer these questions."

Article: Ferreri AJM, Ponzoni M, Guidoboni M, Resti AG, Politi LS, Cortelazzo S, et al. Bacteria-eradicating therapy with doxycycline in ocular adnexal MALT lymphoma: a multicenter prospective trial. J Natl Cancer Inst 2006;98:1375-1382.

Editorial: Zucca E, Bertoni F. Chlamydia, or not Chlamydia, that is the question: which is the micro-organism associated with MALT lymphomas of the ocular adnexa? J Natl Cancer Inst 2006;98:1348-1349.

Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jncicancerspectrum.oxfordjournals.org/.

The Occurence Of Ocular Rosacea

2006-09-26T10:04:00.000-07:00

Up to one half of patients with rosacea may experience symptoms related to their eyes. Ocular rosacea, as it is called, frequently precedes the other manifestations on the skin. Most of these eye symptoms do not threaten sight, however. Telangiectasia may appear around the borders of the eyelid, the eyelids may be chronically inflamed, and small lumps called chalazions may develop. The cornea of the eye, the transparent covering over the lens, can also be affected, and in some cases vision will be affected.

Perioral-Nasal-Ocular Dermatitis

2006-09-15T10:35:00.000-07:00

Ocular Rosacea Difficult to Detect in Dark-Skin Patients

2006-09-07T11:22:00.000-07:00

Ocular rosacea is not a rare disease, but it can be missed easily in individuals with dark skin. Because this can be a sight-threatening disease, ophthalmologists should pay added attention to patients who present with ocular irritation and chronic severe meibomitis, explained Nibaran Gangopadhyay, MS, who described the clinical features and how best to manage the disorder at the annual meeting of the American Society of Cataract and Refractive Surgery.
Chronic meibomitis evident as inflamed lids with rounded lid margins and telangiectasia. "Ocular rosacea is a chronic acneiform disorder that affects both the skin and eye. It is a syndromal etiology that is believed to be more common in Caucasian patients and nearly nonexistent in the black population," Dr. Gangopadhyay said. "However, when we started to look more carefully at non-Caucasian patients, we found that ocular rosacea was more common than had previously been believed."
Dr. Gangopadhyay, director of Eye Care, Techno India, Kolkata, previously worked as a consultant in the department of Cornea in LV Prasad Eye Institute and his colleague Dr. Merle Fernandes from the same institute conducted a retrospective analysis in which patients with grades 1 to 4 acne rosacea were included. Eleven records were excluded because of inadequate documentation, inaccurate data, or acne vulgaris was misdiagnosed as acne rosacea. The investigators evaluated the patient demographic data, clinical history and progression of clinical features, treatment, and the clinical course of the disease.
Peripheral marginal keratitis with infiltration and vascularization affecting nearly a quadrant of the lower cornea, suggesting rosacea. "Twenty-two patients, 13 of whom were male, were found to have features of ocular rosacea. Studies in the literature report a slight female predominance, but more and more articles are reporting that the sexes are equally affected," Dr. Gangopadhyay said.
The mean patient age was 37.2 ± 17.1 years, with a range from 6 to 65 years. The original follow-up was about 6.4 months. Three patients were lost to follow-up.
Figure 3 Peripheral marginal keratitis with infiltration and vascularization affecting nearly a quadrant of the upper cornea, suggesting rosacea. (Figures courtesy of LV Prasad Eye Institute) "Twelve of the 22 patients had a history of ocular irritation, and half of them had been evaluated previously by an ophthalmologist," he said. "What was surprising was that none of our patients had received a diagnosis of skin involvement before we examined them." The previous diagnoses were marginal keratitis, sclerosing keratitis, Staphylococcus infection, fungal keratitis, corneal ulcer, chronic conjunctivitis, and so on.
Most of the patients had more than two symptoms; those appearing most often were redness (63.6%), watering (59.1%), pain (50%), and decreased vision (36.4%). The most common signs were meibomitis (90.8%), corneal scars (59.1%), and blepharitis (50%), with corneal scars being one of the most important causes of loss of visual acuity, according to Dr. Gangopadhyay.
Clinical features of ocular rosacea were found in only 9% of patients before a diagnosis of rosacea was established. Therefore, most disease was diagnosed when patients were examined by Dr. Gangopadhyay and his colleagues. "We diagnosed the disease in 70% of cases at the first presentation, but we missed the diagnosis in nearly a third of the cases," he said.

Statistics On Ocular Rosacea

2006-08-29T11:35:00.000-07:00

It is reported that 50 to 60% of all rosacea sufferers also have some sort of symptoms with their eyes which is known as ocular rosacea. In one study (Starr, McDonald 1969) it was found that ocular rosacea symptoms occurred in 58% of patients.

Sometimes (perhaps 20% of the time) ocular rosacea problems occur prior to the typical skin related rosacea symptoms though it is more usual (about 53% of the time) for the skin symptoms to appear first. (Borrie, 1953).

Ocular rosacea patients generally have chronically "bloodshot" eyes, dry eyes, and blepharitis (inflammation and debris of the eyelid margins). In severe ocular rosacea, there may be corneal ulceration (infection) which, if untreated, may even lead to perforation of the eye. This can be a potentially blinding complication.

People with rosacea have a tendency to be overall more dehydrated than others. The body is approximately 65% water while the eye is 96% water. Increasing your water intake will increase the moisture in the eye (thereby decreasing irritation and dryness). It has been found that increasing the amount of water consumed daily can ease the symptoms of ocular rosacea for many.

Ocular Rosacea Overview

2006-07-10T11:56:00.000-07:00

Ocular rosacea is associated with a chronic skin condition known as rosacea or acne rosacea. This common problem usually affects those with light skin, and in the early stages is characterized by redness and bumps concentrated on the forehead, nose and cheeks. One of the earliest symptoms of rosacea, often experienced during puberty, is facial flushing. Flushing for any reason is liable to bring on an attack of redness and pimples. Even people who are being treated for rosacea can relapse if they flush. The following triggers can set it off:
strong emotional reactions, like embarrassment or anger
hot drinks
alcoholic beverages
stress
sunlight
extreme hot and cold temperatures
vigourous exercise
menopause
some medications Eventually, the skin may become chronically red, irritated and inflamed. The most severe cases go on to develop rhinophyma, the thickening of the skin and connective tissues of the nose, often resulting in some facial scarring. Women are affected more often than men, but men tend to have more severe symptoms Approximately 60% of patients with rosacea develop ocular rosacea. These patients most commonly experience irritation of the lids and eye, occurring when the oil-producing glands of the lids become obstructed. Styes, blepharitis, dry eye, and chronically bloodshot eyes are also typical conditions. Sometimes scales and crusts can form on the eyelids; there may also be sensitivity to light or blurry vision. In severe ocular rosacea, there may be corneal ulceration, which, if untreated, may even lead to corneal scarring. This is a potentially blinding complication.

Tips On Eye Lid Hygiene

2006-07-10T11:54:00.000-07:00

EYE LID HYGIENE
1. Soak a clean washcloth in warm water and wring out.
2. Apply the moist, warm cloth across both eyes for 5-10 minutes.
3. Wrap the washcloth around your index finger and massage the base of the eyelashes with warm water.
4. Rinse both eyes with warm water.
5. If desired, cleanse the lid margins with diluted no-tears baby shampoo, or specially formulated cleansing pads (available over the counter).
6. Repeat this process when you wake up and at bedtime.

Dry Eye Hot Spots In The U.S.

2006-06-30T08:03:00.000-07:00

If you have a hard time wearing contact lenses, or if your eyes are stinging and red, you might be the victim of dry eye.
It is one of the most common complaints patients bring to their eye doctors. The National Women's Health Resource Center (NWHRC), a nonprofit group in Red Bank, N.J., estimates that 20.7 million Americans are affected by the syndrome, and that the malady accounts for one-fourth of all eye doctor office visits. Dry eye has many causes, from hormonal shifts to the surrounding environment.
"It's a common problem in people of all ages," says Dr. Andrew Caster, medical director of the Caster Eye Center in Beverly Hills, Calif. "It becomes more of a problem as we get older, and even more so among post-menopausal women."
For the vast majority of people, dry eye is simply an annoyance. If left untreated, however, it can be debilitating. Symptoms include itching, irritation, blurred vision, dryness and even the feeling of a foreign body in the eye. Some patients sense a sandy, gritty feeling, while others say their eyes feel tired and sore. People suffering from these symptoms may have trouble wearing contact lenses, reading, driving at night or using computers.
According to Dr. Michael Ehrenhaus, director of cornea and external disease and refractive surgery at Long Island College Hospital in Brooklyn, N.Y., dry eye is often misdiagnosed as something else--say, allergies. That can delay treatment.
Ehrenhaus says the syndrome usually results in a decreased ability to produce tears, which normally keep the eyes moist, or a problem with the actual tears themselves. Hormonal changes due to aging and menopause, and medical factors such as vitamin deficiencies, thyroid problems and diabetes, can aggravate dry eye, but another trigger can be the environment.
"Dryer air and higher altitudes can aggravate [dry eye]," says Caster. "Or, for instance, if you heat the air during the winter, that can dry the eye."
NWHRC has created a list, sponsored by a pharmaceuticals company, of 100 U.S. cities that are "Dry Eye Hot Spots." The number one hot spot on the list is Las Vegas, followed by four cities in Texas. The cities were ranked based on data archived by the National Oceanic & Atmospheric Administration's National Climatic Data Center and the Environmental Protection Agency. To rank the cities, researchers looked at factors known to aggravate dry eye symptoms: humidity, wind, altitude, pollutants and ocular allergens on a national, state and municipal level.
The simplest way to soothe dry eye is by using over-the-counter artificial tears several times throughout the day. For those who wear contact lenses, Caster suggests laser vision correction, which eliminates the need for contacts altogether.

Ocular Rosacea And Its Treatment

2006-06-27T08:02:00.000-07:00

Ocular Rosacea is an inflammatory eye condition often associated with acne rosacea. Ocular rosacea can cause a persistent burning or gritty feeling in the eyes. For others, ocular rosacea manifests itself as inflamed and swollen eyelids with small inflamed bumps, eyelashes that may fall out, compounded by bloodshot eyes (Dr. Thiboutot). The ophthalmic signs of ocular rosacea can vary widely, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. (These conditions will be described in detail below.) The term ophthalmic or ocular rosacea covers all these signs. The most frequent signs, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts, quite similar to seborrheic dermatitis, with which ocular rosacea is often confused. Pain and photophobia (abnormal sensitivity to light) may be present. The ocular complications are independent of the severity of facial rosacea (Drs. Gerd Plewig & Albert M. Kligman).
It is reported that 50 to 60% of all rosacea sufferers also have some sort of symptoms with their eyes which is known as ocular rosacea. In one study (Starr, McDonald 1969) it was found that ocular rosacea symptoms occurred in 58% of patients.
Sometimes (perhaps 20% of the time) ocular rosacea problems occur prior to the typical skin related rosacea symptoms though it is more usual (about 53% of the time) for the skin symptoms to appear first. (Borrie, 1953).
Ocular rosacea patients generally have chronically "bloodshot" eyes, dry eyes, and blepharitis (inflammation and debris of the eyelid margins). In severe ocular rosacea, there may be corneal ulceration (infection) which, if untreated, may even lead to perforation of the eye. This can be a potentially blinding complication.
People with rosacea have a tendency to be overall more dehydrated than others. The body is approximately 65% water while the eye is 96% water. Increasing your water intake will increase the moisture in the eye (thereby decreasing irritation and dryness). It has been found that increasing the amount of water consumed daily can ease the symptoms of ocular rosacea for many.

Eye Symptoms May Separate Rosacea And Lupus

2006-06-16T11:07:00.000-07:00

While the facial effects of rosacea and lupus may sometimes be confused, the presence of eye symptoms may point definitely to rosacea, as it almost never occurs in lupus flares."The presence of ocular involvement can be very helpful in differentiating active lupus from active rosacea," said Dr. Guy Webster, associate professor of dermatology at Jefferson Medical College.The two disorders may have a similar appearance. Like rosacea, lupus sufferers often have redness across the central portion of the face, often in a butterfly pattern. Although both rashes can be smooth in texture, especially in early rosacea, the presence of bumps and pimples, which rarely occur in a lupus flare, may help differentiate the two diseases.Moreover, unlike lupus, as many as 50 percent of rosacea patients may also have ocular signs. Visually, an eye affected by rosacea often appears simply to be watery or bloodshot. Patients may feel a gritty or foreign-body sensation in the eye, or have a dry, burning or stinging sensation.Inflammation of the eye or eyelid, called blepharitis, is also very common in rosacea, Dr. Webster said.

Controlling Pink Eye

2006-06-06T07:51:00.000-07:00

Conjunctivitis, more commonly known as pinkeye, is a contagious infection that often strikes children but can also affect adults. Pinkeye occurs when the tissue lining the eyelid becomes infected, and causes redness and itching of the eye.
Pinkeye is most often caused by a virus, but may also be caused by bacteria, fungi, or in rare cases, a parasite. The U.S. National Library of Medicine says antibiotics, typically eye drops, will only treat pinkeye caused by bacteria. Viral pinkeye will usually heal on its own without treatment, the NLM says.
Frequent handwashing is recommended to prevent the spread of pinkeye. You should also avoid touching your eyes or sharing eye cosmetics or towels with another person. Frequent washing of pillow cases, and regular removal and disinfection of contact lenses may also prevent infections from spreading or recurring.

Rosacea Sun Care Should Include Eye Care

2006-05-31T08:31:00.000-07:00

Because sun exposure was cited as the most common rosacea trigger by 81 percent of patients responding to a National Rosacea Society survey, it may be important to remember a few things over the summer when sunlight is at its height. Here are some tips for protecting yourself from the sun:
Avoid the sun as much as possible. Limit the amount of time spent in direct sunlight, especially between the hours of 10 a.m. and 4 p.m., when sun is the strongest.
Protect your face. Use a sunscreen year round, but especially in the summer. Make sure it has an SPF of 15 or higher and is effective against both UVA and UVB rays.
Apply sunscreen at least 30 minutes before going outdoors. Apply it liberally and periodically throughout the time spent in the sun.
Try a pediatric sunscreen. If you have sensitive skin, a pediatric formulation or a hypoallergenic sunscreen may minimize irritation.
Wear a hat. Make sure the hat has a wide brim or visor. You'll have added protection and may even make a fashion statement.
Stay cool. Seek the shade as much as possible and remember to stay hydrated by taking along a water bottle. Chewing on ice chips also helps, especially with flushing.
Don't take a vacation from medical therapy. Be sure to continue your normal cleansing routine as well as the medical therapy prescribed by your doctor.

Study Uncovers Clues for Possible Ocular Rosacea Diagnostic Test

2006-05-31T08:27:00.000-07:00

In a study funded by a grant from the National Rosacea Society (NRS), researchers may have uncovered clues that may lead to a diagnostic marker for subtype 4 (ocular) rosacea, a chronic condition that may have severe consequences if left untreated -- including reduced vision. In publishing the final study results in the medical Journal of Proteome Research,1 the researchers noted that ocular rosacea often may be difficult to diagnose, especially in the absence of signs of rosacea on the skin. In addition, it may be frequently overlooked by non-eye doctors.
"Ocular rosacea is potentially a vision-threatening condition that may be easily missed," said Dr. Mark Mannis, chairman of ophthalmology at the University of California, Davis and one of the study's investigators. "We are excited that our study may ultimately lead to the first diagnostic test that could alert physicians to eye involvement before it grows more serious."
Samples of tears from 16 ocular rosacea patients and 21 individuals without rosacea were collected by Dr. Mannis and colleagues and were analyzed for the presence of oligosaccharides, a type of carbohydrate that may be found in the mucus component of the tear fluid. Oligosaccharides are known to be sensitive to the biochemical environment and could be an indicator of disease states.
The researchers found that the presence of high levels of oligosaccharides may be a diagnostic indication of ocular rosacea and that high levels of 13 particular types of the compound were associated with rosacea and may serve as more specific markers for the disorder. Since a general increase of oligosaccharides may not necessarily be specific to rosacea, they emphasized that the types of oligosaccharides found in greatest abundance in rosacea patients should be evaluated in further research for their specificity as markers for ocular rosacea.
Ocular rosacea may be present in varying degrees in up to 50 percent of rosacea sufferers. 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. Typical symptoms of ocular rosacea may include a watery or bloodshot appearance, foreign body sensation, burning or stinging, itching, light sensitivity, blurred vision, and visible blood vessels or redness of the eyelid. A history of styes and feeling of dryness in the eyes are also key indicators.
"We plan to further investigate which types of oligosaccharides are the best indicators of rosacea in order to achieve even greater accuracy in distinguishing ocular rosacea from normal patients," Dr. Mannis said.

Associated Reference
An HJ, Ninonuevo M, Aguilan J, Liu H, Lebrilla CB, Alvarenga LS, Mannis MJ. Glycomics analyses of tear fluid for the diagnostic detection of ocular rosacea. Journal of Proteome Research. 2005;4:1981-1987

Approval For Oracea Rosacea Treatment

2006-05-31T08:24:00.000-07:00

CollaGenex said Tuesday it has received U.S. approval to market Oracea, which the company said is the first approved oral rosacea drug.
The company said the Food and Drug Administration has cleared for market Oracea to treat adults with the inflammatory lesions, including papules and pustules, caused by the skin condition.
CollaGenex said it would roll out the new dermatologic drug in July.
"Oracea is the first FDA-approved, orally-administered, systemically-delivered drug to treat rosacea," the company said in a statement.
Rosacea affects about 14 million adults in the United States, CollaGenex said.
"Oracea is the first of a series of dermatology products we have in development, and we are very pleased that our NDA was approved by the FDA within 10 months of submission," said Colin Stewart, CollaGenex's president and chief executive officer.

Keratitis May Occur With Ocular Rosacea

2006-05-22T11:02:00.000-07:00

Keratitis is one of the more serious conditions which may occur in relation to ocular rosacea. Keratitis is a term used to cover a range of ocular conditions where there is infection or inflammation of the cornea. This condition may result in severe eye pain, blurry vision and sensitivity to light. Medical evaluation and treatment of keratitis is absolutely essential. Minor corneal infections are commonly treated with anti-bacterial or anti-fungal eye drops. If the problem is more severe, a person may receive more intensive antibiotic treatment to eliminate the infection and may even require steroid eye drops to reduce inflammation

Clinical Treatment of Ocular Rosacea

2006-05-17T08:39:00.000-07:00

By Roger M. Kaldawy, MD, John E. Sutphin, MD, And Michael D. Wagoner, MDEdited By Sharon Fekrat, MD, And Ingrid U. Scott, MD, MPH

Rosacea is a common, chronic skin disease affecting the face. It can resemble acne, with papules and pustules appearing on the cheeks, forehead and nose. Alternatively, it may appear as flushing and redness, either on the cheeks or the tip of the nose. It is seen more often in women and in those who have Celtic and northern European ancestry.In addition to skin problems, ocular involvement is common and may be the presenting complaint. Ocular irritation is usually worse upon awakening and when performing prolonged visual tasks such as reading, driving or using the computer. At such times, variable vision may occur with transient improvement after blinking.The severity of ocular rosacea does not always correlate with the severity of cutaneous changes. It is important that ophthalmologists recognize the spectrum of clinical findings of ocular rosacea and provide appropriate therapeutic intervention.

Pathophysiology
Tear film disturbances are responsible for the vast majority of subjective complaints and objective findings in ocular rosacea. The reduced amount and altered character of meibomian gland secretions result in destabilization of the lipid portion of the tear film and increased tear evaporation rates. More than one-third of patients with rosacea also have impaired aqueous tear secretion, further contributing to ocular surface desiccation.The most serious complications of ocular rosacea probably result from reactions of the sclera, limbus and cornea to staphylococcal endotoxins or cell-mediated hypersensitivity responses to staphylococcal antigens. The variability in response of patients with ocular rosacea to these immune reactions may account for the extreme variability in clinical signs and symptoms associated with this disorder.

Clinical Findings
The cheek, nose and forehead may have persistent erythema, telangiectasia, papules, pustules and hypertrophic sebaceous glands. In advanced cases, rhinophyma may occur. The eyelid margin may be erythematous and thickened, with telangiectatic vessels around meibomian gland orifices, which are often plugged with thickened, yellowish secretions. Multiple calcific concretions may be seen on the palpebral conjunctiva, along with sequelae of previous treated and untreated chalazia.The tear film, which may have decreased height and increased debris, may break up rapidly between blinks. The conjunctiva may be chronically hyperemic with inferior palpebral follicles. Mucopurulent discharge may be present if acute staphylococcal blepharoconjunctivitis is present. Recurrent episcleritis is not uncommon, but scleritis is rare.Punctate epithelial erosions are frequently present, especially inferiorly. Occasionally, peripheral corneal infiltrates may occur. These focal areas of limbal stromal inflammation may be single or multiple, may or may not have associated epithelial defects and are often associated with limbal vascularization, particularly after multiple recurrent episodes.Rarely, there may be circumferential extension of limbal stromal inflammation with development of an epithelial defect, stromal thinning with potential perforation and/or microbial superinfection. Peripheral corneal vascularization may progress toward the visual axis with lipid deposition, scarring and opacification at the leading edge; this may result in severe visual impairment in neglected cases.

Drug Treatment
Tetracycline derivatives are the mainstay of therapy for ocular rosacea. Our standard regimen is to start with 100 milligrams of doxycycline orally twice a day for one month, after which it is used once daily for at least two more months.Therapeutic response. Patients are advised that there will be a delayed therapeutic response of several weeks. At three months, the medication is adjusted according to the therapeutic response: For marked improvement, the medication can be tapered to 100 mg every other day for the next three months. For mild to moderate improvement, 100 mg is continued on a daily basis. After six months, patients may go on “doxycycline vacations” for two to three months. Eventually symptoms will recur in most cases, and periodic reinstitution of low maintenance doses is necessary.Systemic vs. topical. For patients who can’t tolerate systemic tetracycline therapy, topical metronidazole gel (NetroGel) 0.75 percent twice daily or 1 percent daily, applied to the eyelids, has been shown to be safe and effective.Side effects. The major side effect that compromises the ability to use doxycycline is gastrointestinal disturbance. This is probably dose-related; it is ameliorated by taking the medication with food and is better tolerated with time. Photosensitivity may be a problem in some patients. All patients are advised to avoid excessive sun exposure and to use appropriate skin screening agents until their response to doxycycline is known.Contraindications. Doxycycline is contraindicated in pregnant women, nursing mothers and children under the age of 8.

Three-Step Approach
Tetracycline derivatives are most effective when used in conjunction with the following three-step approach:

1. Normalize tear film disturbance.
Warm compresses. These help further minimize meibomian gland obstruction and improve lipid flow into the tear film.
Punctal occlusion. Temporary or permanent occlusion is useful if aqueous tear production is deficient.
Artificial tear substitutes. These are useful until ocular surface wetting, punctate epitheliopathy and variable vision during prolonged visual tasks have improved.
2. Control bacterial overgrowth.
Lid hygiene. This is part of a long-term maintenance program to minimize meibomian gland obstruction, improve lipid flow into the tear film and control bacterial overgrowth.
Topical antibiotics. These are useful in the first month of treatment to reduce bacterial flora. Generally, they should be used when acute mucopurulent blepharoconjunctivitis, marginal corneal infiltrates or peripheral ulcerative keratitis are present.
3. Control inflammatory and hypersensitivity reactions.
Topical corticosteroids. These are useful in the first month of treatment to reduce ocular surface inflammation. Generally, they should be used if marginal corneal infiltrates, peripheral ulcerative keratitis without progressive thinning and/or vascularization are present.
Topical progestational steroids. Compounded medroxyprogesterone 1 percent may be used if peripheral ulcerative keratitis with progressive thinning is present.
In addition, topical progestational steroids are useful in conjunction with corticosteroids for treating progressive vascularization.

Dr. Kaldawy is assistant professor of ophthalmology at Boston University; Drs. Sutphin and Wagoner are both professors of clinical ophthalmology at the University of Iowa, Iowa City.

Who Gets Ocular Rosacea?

2006-05-10T07:27:00.000-07:00

Diagnosis of Ocular Rosacea

2006-05-01T12:52:00.000-07:00

The diagnosis of ocular rosacea should be considered when a patient's eyes have one or more of the following signs and symptoms: watery or bloodshot appearance (interpalpebral conjunctival hyperemia), foreign body sensation, burning or stinging, dryness, itching, light sensitivity, blurred vision, telangiectases of the conjunctiva and lid margin, or lid and periocular erythema. Blepharitis, conjunctivitis, and irregularity of the eyelid margins also may occur. Meibomian gland dysfunction presenting as chalazion or chronic staphylococcal infection as manifested by hordeolum (stye) are common signs of rosacea-related ocular disease. Some patients may have decreased visual acuity caused by corneal complications (punctate keratitis, corneal infiltrates/ulcers, or marginal keratitis). Treatment of cutaneous rosacea alone may be inadequate in terms of lessening the risk of vision loss resulting from ocular rosacea, and an ophthalmologic approach may be needed. Ocular rosacea is most frequently diagnosed when cutaneous signs and symptoms of rosacea are also present. However, skin signs and symptoms are not prerequisite to the diagnosis, and limited studies suggest that ocular signs and symptoms may occur before cutaneous manifestations in up to 20% of patients with ocular rosacea. Approximately half of these patients experience skin lesions first, and a minority have both manifestations simultaneously.

Facts On Ocular Rosacea

2006-04-26T11:03:00.000-07:00

More than 10% of Americans have rosacea; of this percentage, 60% experience ocular rosacea.
Ocular Rosacea is not life-threatening, however approximately 5% of patients with rosacea manifest corneal disease, which may be severe and can lead to blindness via corneal ulceration, perforation, secondary infections, or corneal opacification from complete vascularization.
Rosacea is recognized much more commonly in fair-skinned Caucasian patients but also occurs in other populations.
Although darker skin is generally better defended against the sun due to its increased level of natural pigmentation, and therefore less likely to be affected by rosacea, symptoms of inflammation are probably also less superficially evident.
Twice as many females are affected by rosacea as males, however those males whom are affected tend to have more severe symptoms, in particular, rhinophyma.
All ages can be affected, but most rosacea patients are between 40 and 70 years of age

Treating Ocular Rosacea

2006-04-20T10:06:00.000-07:00

Eye involvement is quite common with rosacea, with symptoms including blepharitis, conjunctivitis, and even keretitis. Persistent burning, the feeling of grittiness in the eyes, inflamed and swollen eyelids with small bumps, or eyelash loss, along with bloodshot eyes can all be signs of ocular rosacea. The most frequent signs are chronically inflamed margins of the eyelids with scales and crusts. Light sensitivity is also common.

Treatment of ocular rosacea requires a highly motivated patient. With regard to ocular rosacea, treatment usually consists of lid hygiene measures, such as daily cleansing with cotton-tipped applicators (Q-tips). This entails cleansing the bases of the lashes with a moistened Q-tip to remove debris and oily secretions. Some ophthalmologists advocate cleansing with diluted baby shampoo, while others believe that plain water is best.

Often, an antibiotic or combination antibiotic-steroid ointment is prescribed for various periods of time, depending on response.

It may aslo be beneficial to include in your diet three servings per week from the Omega-3 supplements. These essential fatty supplements aid in an overall balanced diet as well as easing the discomfort of ocular rosacea.

Antibiotics from the tetracycline family such as Doxycycline and Minocycline are often prescribed to bring symptoms of ocular rosacea under control. Studies of the use of Doxycycline by patients with ocular rosacea showed significant improvement with a variety of signs/symptoms including dryness, itching, blurred vision and photosensitivity, scales, erythema and telangiectasis (Quarterman 1997).

For dry eyes, some rosacea sufferers use Celluvisc Eye treatment drops found at drug stores or grocery stores. They are much thicker than the usual eye drops and can be used without taking out contact lenses. Because of the thickness of the eye drops, they may temporarily impair vision.

Another ocualr rosacea solution that many have found helpful is The tan-colored Rosacea-Ltd III disk. The disk may be applied over the eyelids and around the eyes to calm the redness and burning in the eye area by using only one (1) second in the eye area.

Increasing your water intake will increase the moisture in the eye (decreasing irritation).

Could Your Contact Lens Solution Be Causing Your Eye Irritation?

2006-04-18T09:25:00.000-07:00

FDA is continuing to work closely with the Centers for Disease Control and Prevention (CDC) and Bausch & Lomb to investigate the source of Fusarium keratitis eye infections. The agency supports Bausch & Lomb's decision to voluntarily withdraw ReNu MoistureLoc® contact lens solution from the market until the agencies have had a chance to conclude their investigation.
FDA started its investigation of the Bausch & Lomb manufacturing plant on March 22, 2006, and will continue inspections of the Greenville, SC manufacturing plant and other facilities through next week. While the investigation continues, FDA will work with CDC to identify and confirm cases of Fusarium keratitis reported by state health departments and from FDA Medwatch reports.
FDA and CDC are advising consumers to take precautions to reduce their risk for Fusarium keratitis through preventive practices for contact lens wearers that include:
Wash hands with soap and water, and dry (lint-free method) before handling lenses.
Wear and replace lenses according to the schedule prescribed by the doctor.
Follow the specific lens cleaning and storage guidelines from the doctor and the solution manufacturer.
Keep the contact lens case clean and replace every 3-6 months.
Remove the lenses and consult your doctor immediately if you experience symptoms such as redness, pain, tearing, increased light sensitivity, blurry vision, discharge or swelling.
For more information, please visit FDA’s Contact Lens and Eye Infections page at: http://www.fda.gov/oc/opacom/hottopics/contacts.html

Ocular Rosacea Defined

2006-04-10T11:44:00.000-07:00

Ocular Rosacea is an inflammatory eye condition often associated with rosacea. Ocular rosacea can cause a persistent burning or gritty feeling in the eyes. Ocular rosacea may also manifest itself as inflamed and swollen eyelids with small inflamed bumps, eyelashes that may fall out, compounded by bloodshot eyes. The ophthalmic signs of ocular rosacea can vary widely, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ophthalmic or ocular rosacea covers all these signs. The most frequent signs, which may never progress to a more severe condition, are chronically inflamed margins of the eyelids with scales and crusts; quite similar to seborrheic dermatitis, with which ocular rosacea is often confused. Pain and light sensitivity may also be present. The ocular complications of rosacea are independent of the severity of facial rosacea.

Living With Rosacea And Ocular Rosacea

2006-03-29T12:09:00.000-08:00

The trip to Cabo San Lucas with friends was supposed to be a fun getaway for the 54-year-old woman. But there was one thing she couldn't escape: a chronic condition that had plagued her for several years.
So several times a day she would take cotton swabs and carefully apply baby shampoo under the lids of her eyes. Then on her face she would slather on a topical antibiotic prescribed by her doctor, along with plenty of sunscreen. She was careful not to over indulge in the wonderful Mexican cuisine since spicy foods would only exacerbate her condition ... ditto those margaritas.
As for lounging around the pool under that welcoming tropical sun or sitting in a sauna with her pals in the evening, well, she'd have to pass on that, too.
Rosacea, the woman discovered, was something you can never leave behind.
She isn't alone.
"Not a day goes by that someone doesn't come in our office with it," noted Dr. Matthew N. Harris, a board certified dermatologist with Dermatology Associates of Hinsdale. "There is no cure for rosacea. It does tend to go into its own remission, but there is often a course of flaring, staying calm for a while, then flaring up again."
There are 14 million other Americans struggling with this chronic inflammatory skin condition that can begin as a harmless blush; a slight flushing on the cheeks and nose. If left untreated, the condition can result in a persistent redness that can blossom into unsightly pustules or pimples that spread across the face.
More than half the people with rosacea experience a burning, gritty sensation or dryness in their eyes known as ocular rosacea. With this form, the eyelid edge can be inflamed or appear scaly. And, of course, most everyone with rosacea worries that the condition will progress into the most severe form: the bulbous, red W.C. Fields-style nose, called rhinophyma, which is accompanied by pink, puffy cheeks.
The skin disease is most common in fair-skinned people between ages 30 and 60. While it's more common in women, its more severe forms, like rhinophyma, are likely to be reserved for men. Nearly 70 percent of rosacea patients report lower self-confidence and self- esteem because of the condition, reports the Barrington-based National Rosacea Society.
Patients quickly learn to identify triggers that can incite flare- ups. A few common triggers include foods such as liver, yogurt, cheeses, avocados, soy sauce, spinach, chocolate or vanilla, citrus fruits, spicy or hot foods, alcohol (especially red wine, beer, bourbon, gin, vodka or champagne), hot chocolate, cider and coffee. Stress and anxiety also are likely to induce a flare- up, as are exercise, extreme temperatures, sun exposure, strong winds, high humidity, saunas or hot baths. Medications such as steroids or vasodilators can also cause symptoms. And if you're a woman going through menopause, well, don't even think of having a hot flash.
"It's a battle," agreed Dr. Robert Brodell, spokesman for the American Association of Dermatology. "But our approach is to try to make it better. The tricky part is that triggers and treatment are likely to be different for each patient."
Managing this chronic condition on your own can make matters worse. Products to control acne outbreaks are likely to contain alcohol that dries out the skin and irritates fragile blood vessels, possibly producing even more inflammation and redness. The earlier treatment is begun by a physician, the greater the chance of reducing the inflammatory response and preventing more severe or permanent symptoms.
For rosacea sufferers, Brodell suggests using over-the-counter oil-free makeup. Keep a diary of foods and activities to help identify triggers that worsen the condition. If avoiding trigger foods doesn't keep flare-ups at bay, your doctor will likely prescribe topical antibiotics such as azelaic acid or metronidazole, which are designed to slow down infection in your skin's hair follicles.
If those don't work, an oral antibiotic will be prescribed. Some researchers believe that early use of the drug doxycycline can shrink vessels, thus preventing the severe redness associated with rosecea.
Today, laser treatments can treat both redness and visible blood vessels. Lasers work by using heat to seal the blood vessels, causing them to collapse. Depending on the severity of the condition, treatment can include two to five treatments over a period of weeks, with patients needing to return annually to eradicate new blood vessels. Laser treatment is generally not covered by health insurance.
"Don't give up," urged Brodell. "In the vast majority, we can control it. There is no cure, but it is controllable."

How To Treat Ocular Rosacea

2006-03-21T08:54:00.000-08:00

ocular rosacea celluvisc lubricants eye drops

2006-03-17T12:09:00.000-08:00

It is of utmost importance that those who suffer from ocular involvement lubricate their eyes as often as isnecessary in order to make their eyes comfortable and the inflammation soothed/calmed down. I advise patients to use only preservative-free eye lubricants preferably the single use ones. I found another brand calledRefresh Plus to be very good and less thick than Celluvisc which is also good but thicker.You see, I think what's happening to the eyes is similar to that in the skin. One should discontinue the orals when the eyes are much improved but keep lubricating constantly. Basically, it is just better not to take too much oral meds, if at all possible.

Using Tears For Ocular Rosacea Diagnosis

2006-03-14T10:36:00.000-08:00

Preliminary data from a study funded by the National Rosacea Society have found that the tears of rosacea patients contain different proteins than the tears of people without rosacea. The results point to the potential for a screening test for ocular rosacea in the future.
The study was conducted by a team led by Dr. Mark J. Mannis, chairman of the Department of Ophthalmology at the University of California - Davis.
Tears were collected from 17 rosacea patients and 22 normal controls. The researchers analyzed proteins called mucopolysaccharides in the tears of each group, and identified a distinct pattern in the type and quantity of certain proteins in the rosacea patients' tears that differed from those of the controls.
"This is a very significant finding," said Dr. Mannis. "If our initial results are validated by more extensive research, this may lead to the identification of a diagnostic test — heretofore illusive to investigators."

Publication of results: An HJ, Ninonuevo M, Aguilan J, Liu H, Lebrilla CB, Alvarenga LS, Mannis MJ.. Glycomics analyses of tear fluid for the diagnostic detection of ocular rosacea. Journal of Proteomic Research 2005 Nov-Dec;4(6):1981-7.

Use of Hot Compresses For Ocular Rosacea

2006-03-10T08:45:00.000-08:00

Q: [On regular use of hot compresses] "... My eyes felt better after my routine, however I noticed that my vision would be very blurry for a few minutes and my eyes would get extremely bloodshot. ... I stopped the hot compresses 3 days ago but my eyes are bothering me much more now. ... I would like to know if it is better for my eyes to use the compresses or not."

A: "You are talking about relief of symptoms. The idea behind the warm compresses is dilating the glands that are blocked off. Anything you can do to dilate the glands and help the natural oil lubricate the eye better is going to decrease the eye symptoms. While it does dilate the blood vessels also, which can make the telangiectasia and erythema worse, the idea is to relieve the plugged glands, get those oils that are clogged up flowing again. It may feel worse in the short term, but it will be better overall once you get those glands flowing."

Ocular Rosacea And The Dry Eye Syndrome

2006-03-07T12:59:00.000-08:00

Focusing On Ocular Rosacea

2006-03-03T11:20:00.000-08:00

Cancer Treatment May Affect Ocular Rosacea

2006-02-28T12:18:00.000-08:00

Ocular toxicity is common during adjuvant therapy for early breast cancer and is largely the result of ocular irritation stemming from chemotherapy, a retrospective study suggests.
Ocular toxicity "may be disturbing" for women, investigators note in the February 1st issue of Cancer, and "may justify secondary preventive measures" for those women who develop ocular irritation after an initial cycle of chemotherapy.
By contrast, ocular toxicity during hormonal therapy with a selective estrogen receptor modulator (SERM) alone "seems rather rare," Dr. Lorenzo Gianni from Ospedale degli Infermi in Rimini, Italy and colleagues report, and, therefore, "does not appear to justify a regular program of ocular examination."
Nonetheless, "nurses and physicians should pay attention and inform patients about possible side effects for a prompt ocular evaluation in case of ocular complaints," Dr. Gianni said.
The research team culled data on the incidence and timing of ocular toxicity after adjuvant chemoendocrine treatment for early breast cancer in 4948 women from seven International Breast Cancer Study Group Trials conducted between 1978 and 1999. The women were randomized to receive endocrine therapy with a SERM (tamoxifen or toremifene) alone or with chemotherapy.
A total of 580 instances of ocular toxicity were reported in 538 women (10.9%) during adjuvant treatment, mainly during chemotherapy, Dr. Gianni and colleagues report.
Forty-five women (0.9%) had ocular toxicity during tamoxifen or toremifene therapy alone but only 30 (0.6%) of these cases were deemed possibly related to tamoxifen or toremifene.
"Impaired visual acuity, ocular irritation and cataract were the most frequent side effects, while no cases of confirmed retinopathy were reported," Dr. Gianni said.
In most cases, ocular toxicity developed within the first two months of treatment, with a plateau at the end of chemotherapy. In most of cases, ocular toxicity was no higher than Grade 1 (75%).
For a variety of reasons, it is "very likely that we have underestimated the incidence of ocular toxicity," the authors note in their report.
"The fear of ocular toxicity," Dr. Gianni concluded, "should not influence the (treatment) decision in most cases, but for patients with pre-existing ocular disease the use of an aromatase rather than tamoxifen may be appropriate, keeping in mind that aromatase inhibitors have not been as fully evaluated for ocular and other adverse events."

Dry Eyes Common With Ocular Rosacea

2006-02-24T11:42:00.000-08:00

Eye Problems Not Always Caused By Rosacea

2006-02-22T09:07:00.000-08:00

'Hay fever eyes'
Seasonal allergic conjunctivitis is the eye equivalent of hay fever and affects up to 25 per cent of the general population. The eyes become itchy, watery and red in the summer pollen season - usually from exposure to grass and tree pollen.
A more severe form of this disease seen in children is vernal conjunctivitis where the symptoms are more intense. The eyes are very sticky with a stringy discharge and pain occurs especially when opening the eyes on waking. The eyelid inner membranes swell with the conjunctiva developing a cobblestone appearance, corneal damage may even occur if the condition is left untreated.
Perennial allergic conjunctivitis tends to occur all year round with house dust mite and cat allergy. The symptoms are usually milder than those in seasonal allergic conjunctivitis.
'Eczema eyes'
Atopic keratoconjunctivitis although rare is the most severe manifestation of allergic eye disease occurring predominantly in adult males. It is the eye equivalent of severe eczema. This persistent condition results in constant itching, dry eyes, blurred vision and is associated with corneal swelling and scarring. Eyelid eczema and infection are common and lens cataracts may develop over time.
Contact lens allergy
Contact lens wearers may develop giant papillary conjunctivitis triggered by the constant local irritation of the contact lenses on the conjunctival surfaces. The lining of the upper eyelid is usually most affected. Disposable contact lenses may help settle symptoms but occasionally contact lens wearing has to be suspended.
Never use steroid eyedrops unless under the direct supervision of a doctor. Steroid eyedrops although very effective for treating eye allergies can lead to unwanted side effects such as glaucoma, cataract formation and encourage infections of the eye with resultant corneal scarring.

Tips To Soothe Dry Eye In Winter

2006-02-14T08:32:00.000-08:00

If you're bothered by irritation, burning or a gritty feeling and redness in your eyes, you're not alone. Winter can bring a host of special challenges for rosacea patients, and the effects of dry eye head the list for many.
"Millions of people suffer from dry eye, and it accounts for 17 percent of all ophthalmologic visits," said Dr. Marian Macsai, chairman of ophthalmology at Northwestern University. "We definitely see more of it during the winter months because of the dryness of the environment, and it often accompanies rosacea."
Dr. Macsai explained that dry eye is either an inability to produce natural tears, or occurs because the oily (lipid) layer in the tear film is unhealthy or incomplete. A dry and windy environment can also cause more rapid evaporation of the aqueous layer of tears. In patients with eye (ocular) manifestations of rosacea, this condition is frequently made worse by blockage of the meibomian glands at the base of the eyelashes, which produce the lipids that hold the moisture on the surface of the eye.
In a recent National Rosacea Society survey of 1,780 rosacea patients reporting ocular symptoms, 95 percent said their eyes had felt dry, gritty or irritated, yet only 28 percent said they had been diagnosed with ocular rosacea.
"If the symptoms of ocular rosacea persist, it's a good idea to make an appointment with an ophthalmologist," said Dr. Macsai. 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.
For mild symptoms, Dr. Macsai advises patients to use a humidifier or other means to raise the humidity at home or in work environments. She also noted that artificial tears are available at drugstores to moisturize the surface of the eye.
For her rosacea patients with dry eye problems, Dr. Macsai also emphasizes good eyelash hygiene to minimize blockage of the meibomian glands. She suggests a daily eyelash shampooing that can be performed at the end of a morning shower. Place a drop of baby shampoo on a wet washcloth and carefully rub it onto a closed eye to create a slight lather. Rub the washcloth gently back and forth in a horizontal motion over the upper and lower eyelashes. After shampooing the eyelashes on one eye, shampoo the eyelashes on the other eye.
Then, keeping the eyes closed, put your face under the shower water and rinse off all of the soap until the eyelashes feel squeaky-clean. Gently towel dry. This procedure may also be used in the bath or in front of the sink.
"Your doctor may also prescribe an ointment to rub into your lashes twice a day," Dr. Macsai said. "If any eye symptoms persist or worsen at any time of the year, make an appointment with an ophthalmologist."

Blepharitis Is Common With Ocular Rosacea

2006-02-07T11:59:00.000-08:00

Blepharitis is a common inflammatory condition that affects the eyelids. It usually causes burning, itching and irritation of the lids. Other common symptoms include sandy, itchy eyes, red and/or swollen eyelids, crusty, flaky skin on the eyelids, and dandruff.
In severe cases, it may also cause styes, irritation and inflammation of the cornea (keratitis) and conjunctiva (conjunctivitis). Some patients have no symptoms at all.
Blepharitis is usually a chronic problem that can be controlled with extra attention to lid hygiene. However, it is sometimes caused by an infection and may require medication.
The key to controlling blepharitis is to keep the eyelids and eyelashes clean. Begin by soaking a clean washcloth in hot tap water. Place the compress on closed eyelids for five minutes, and then repeat. Next, gently scrub the eyelids with a washcloth or cotton swab soaked in a mixture of equal parts of baby shampoo and water. Afterward, rinse the lids thoroughly with warm water.
This treatment should be repeated two to three times daily for two weeks, and then reduced to once daily. Like dandruff, there is no cure for blepharitis; but it can be controlled. In some cases, anti-inflammatory and antibiotic drops or ointments are necessary for flare-ups or more severe cases. Remember to remove all mascara before going to bed.
Red, painful eyes may be the result of conditions known as episcleritis and scleritis. Both conditions involve inflamed blood vessels in the eye.

Rosacea Of The Eyes

2006-02-03T11:45:00.000-08:00

Rosacea can also cause a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small inflamed bumps, eyelashes sometimes fall out, compounded by bloodshot eyes. The ophthalmic signs are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ophthalmic rosacea covers all these signs. The ophthalmic complications are independent of the severity of facial rosacea. Rosacea keratitis has an unfavorable prognosis, and in extreme cases can lead to corneal opacity with blindness. The most frequent 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.

Controlling Ocular Rosacea

2006-02-01T09:02:00.000-08:00

Patients with ocular rosacea have ocular manifestations essentially confined to the eyelids and ocular surface.

They most commonly experience irritation of the lids and eye, occurring when the oil-producing glands of the lids become obstructed. Styes, blepharitis, episcleritis, and chronically red eyes are also typical conditions.

Ocular rosacea may also affect the cornea, with problems ranging from minor irritation to potentially severe ocular surface disruption and inflammatory keratitis. This keratitis can lead to sterile corneal ulceration, neovascularization (abnormal blood vessel growth), infections, and occasionally perforations.

The signs and symptoms of ocular rosacea include:
Burning
Chronically red eyes and lid margins
Dry, irritated eyes
Foreign body sensation
Irritated eyelids (blepharitis)
Styes (chalazion)

The ophthalmologist may make the initial diagnosis after a routine eye examination and evaluation of the skin. More often than not, patients with rosacea are under the care of a dermatologist. Those subset of patients with related eye conditions are then referred to the ophthalmologist.

Rosacea is a disease that warrants co-management by an ophthalmologist and a dermatologist.
Patients should avoid the triggers (hot drinks, spicy foods, alcohol, activities that elevate body temperature).
Avoidance of sunlight can minimize flare ups in some patients. The use of sunscreens with a high SPF factor, wearing hats, using sunglasses and umbrellas may decrease ultraviolet light exposure outdoors.
Controlling the skin inflammation may provide symptomatic relief to the related eye manifestations. Diligent lid hygiene is suggested.
Medications which may be used for treatment may include artificial tears, oral antibiotics (doxycycline, tetracycline, clarithromycin, or metronidazole), erythromycin ointment, topical metronidazole, and topical steroids.

Testing For Ocular Rosacea

2006-01-25T09:01:00.000-08:00

A Glycomics approach to detect disease is illustrated in the analyses of human tear fluid for rosacea. The diagnosis of ocular rosacea is particularly challenging in a subgroup of patients that do not present with typical facial skin findings but have ocular signs and symptoms. Indeed, up to 90% of patients with ocular rosacea may have neither obvious roseatic skin changes nor a previous diagnosis of rosacea. Tear fluid was collected from 37 subjects (21 controls and 16 patients with ocular rosacea) after conjunctival stimulation with filter (Schirmer) paper. O-linked oligosaccharides were released from tear fluid by -elimination and then purified using solid-phase extraction. Mass spectra were recorded on an external source HiResMALDI with a 7.0 T magnet. Mass spectra were obtained in both the positive and negative modes. However, signals were stronger in the negative mode. Tear fluid samples from rosacea patients yielded distinctive clusters of peaks that extend to higher masses. Patients with rosacea presented several oligomeric series that were not found in the controls. To discriminate the ocular rosacea cases from the normal controls, the sum of absolute intensities of 13 series corresponding to nearly 50 identified mass spectrum peaks was used. Thirty-six out of the 37 samples were correctly classified. This yields a sensitivity of 100% (95% CI 79.5-100) and specificity of 95.2% (95% CI 76.2-99.9). The high abundance of oligosaccharides in the tear fluid of patients with rosacea may lead to an objective diagnostic marker for the disease.

Tear fluid levels of MMP-8 are elevated in ocular rosacea-treatment effect of oral doxycycline.

2006-01-19T09:22:00.000-08:00

Ocular rosacea (OcR) is a chronic inflammatory disease especially affecting lid margins. Previous studies have shown that it is accompanied by increased levels and activation of tear fluid gelatinases. Matrix metalloproteinase 8 (MMP-8; collagenase 2) levels and activation are commonly elevated in many inflammatory conditions. Therefore we studied here whether MMP-8 concentration and activation in tear fluid are increased also in OcR, and if an oral doxycycline regimen could rectify the situation.

METHODS: Tear fluid samples were collected from 22 OcR patients and 22 healthy controls. The OcR patients were then treated with an oral doxycycline regimen for 8 weeks and tear fluid samples collected again after 4 and 8 weeks. Conjunctival brush cytology and patients' subjective symptoms were scored. MMP-8 concentrations in the tear fluid were assessed by immunofluorometric assay and the molecular forms and isoenzyme expression of MMP-8 were studied by Western immunoblotting.

RESULTS: The mean MMP-8 concentration was statistically significantly higher in OcR (156.8+/-207.4 mug/ml) than in the normal subjects (53.5+/-66.7 mug/ml) (P=0.036), but decreased to 79.2+/-141.6 mug/l and 53.6+/-75.2 mug/l after 4 and 8 weeks doxycycline treatment, respectively. There was a statistically significant difference between the untreated OcR and the MMP-8 results after 4 or 8 weeks of oral doxycycline (P=0.041 and 0.069, respectively) and the OcR patients experienced statistically significant relief of their subjective symptoms (P=0.0001) after the doxycycline regimen. Both the normal and OcR tear fluid contained the larger, 60-80 kDa highly- glycosylated polymorphonuclear leukocyte-type MMP-8 isoform in Western immunoblotting, but not the 45-55 kDa less glycosylated mesenchymal-type isoform. MMP-8 activation was in practice present only in the OcR samples, and was inhibited by oral doxycycline.

CONCLUSIONS: MMP-8 concentration and activation degree in tear fluid are increased in OcR, probably reflecting increased inflammatory activity. Doxycycline effectively reduces these pathologically excessive levels and activation of MMP-8, and relieves patients' subjective symptoms.

PMID: 16411105 [PubMed - as supplied by publisher]

Ocular Alllergic Responses

2006-01-13T11:57:00.000-08:00

The eye is a common site of inflammation. Because the large majority of eye allergies involve the conjunctiva, the terms "ocular allergy", and "allergic conjunctivitis" are used synonymously. The clinical presentation of the various forms of allergic conjunctivitis can vary greatly, from mild symptoms unaccompanied by ocular signs, to severe disease with vision-threatening complications.
Although an IgE-mediated immediate hypersensitivity reaction has been demonstrated or postulated in many types, the pathophysiology underlying the allergic conjunctivitides is not fully understood. Great variety of available pharmacologic options is an evidence of the complexity of the chemical reactions associated with mast cell degranulation and mediator release causing the onset of allergic signs and symptoms.
After presentation of an actual case, this review provides an update on the various forms of ocular allergies focusing on the clinical features that help to differentiate different forms from each other and management.
INTRODUCTION
The term atopy, as first described by Cocoa and Cooke, refers to allergic reactivity in persons with a hereditary predisposition who react to certain antigens scratched into their skin with a wheal and flare reaction. This reaction is mediated by IgE antibodies, fixed to the surface of mast cells leading to degranulation of the mast cells. The name atopy comes from the Greek word "atopos" meaning out of place. The major atopies include hay fever, asthma and atopic dermatitis. Minor atopic conditions are non-hereditary angioedema, idiopathic urticaria and food allergies.
Allergic disease is common, affecting 15% of the world’s population; males are overrepresented in that number. Many of these patients also have eye disease ranging from mild seasonal allergic conjunctivitis to chronic vision threatening inflammation especially due to corneal involvement as in the cases of vernal or atopic keratoconjunctivitis.
There are 4 main types of allergic eye diseases: allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. We herein discuss the clinical features, diagnosis and management of all these groups.
ALLERGIC CONJUNCTIVITIS
Seasonal (SAC) and perennial (PAC) allergic conjunctivitis are the most common forms of allergic conjunctivitis SAC representing approximately half of the cases of ocular allergy.
Symptoms include itching, burning, watery or sometimes mild mucoid discharge and usually bilateral. The conjunctivae are usually mildly injected and edematous leading to a "milky" appearance. Fine papillary hypertrophy of the upper tarsal conjunctiva may occur. Additionally the venous congestion can cause the appearance of dark circles around the eyes called "allergic shiner". Many individuals also have concurrent nasal symptoms and because of the itchy nose they present a special habitus called "allergic salute". Corneal involvement is not among the findings. PAC is a variant of SAC that is chronic with year-round symptoms. In SAC the allergens are the pollens, and in PAC dust, mite feces, animal dander and feathers are the common antigens.
Pathophysiologic features of SAC and PAC are prototypic type I anaphylactic hypersensitivity reactions. In sensitized individuals the allergen crosslinks IgE antibodies on the surface of mast cells and basophils, resulting in the degranulation of these cells with release of mediators including histamine, prostaglandins, leukotrienes, and kinins. Patients with SAC and PAC have elevated levels of IgE in their tears and serum and pollen specificity has been demonstrated in both diseases.
Management begins with the avoidance of known allergens. Iced artificial tears or cold compresses may suffice to relieve mild symptoms. Pharmacotherapy is based on the severity of the clinical signs and symptoms. Topical antihistamines (e.g. pheniramine maleate, antazoline phosphate, pyrilamine maleate and levocabastine), usually in combination with decongestants (e.g. naphazoline) are the mainstay of the treatment. They have an immediate effect and exert their effect by competitively and reversibly blocking the receptors. Therefore they can be used on an "as necessary" basis. Topical non-steroidal antiinflammatory drugs (e.g. ketorolac tromethamine, flurbiprofen) inhibit the activity of cyclooxygenase pathway and therefore the production of the prostaglandins. They are especially useful for the vasodilatation and edema findings. Mast cell stabilizers (e.g. cromolyn sodium, nedocromil, lodoxamide) act by preventing the calcium influx across mast cell membranes and therefore inhibit the degranulation. They also have some inhibitory effect on neutrophils and eosinophils. They should be used prophylactically and on a regular basis for effectiveness. In severe cases short term topical steroids may be considered, keeping in mind that long term use may be associated with cataracts, glaucoma, and superinfections of the ocular surface. In patients with significant nasal symptoms oral antihistaminics can also be used.
VERNAL KERATOCONJUNCTIVITIS
Vernal keratoconjunctivitis (VKC) is a chronic bilateral conjunctival inflammatory disorder typically affecting young males. The onset of the disease is generally before age 10; it lasts 2 to 10 years and usually resolves after puberty. The Mediterranean area and West Africa are the areas of the greatest numbers of patients. There is a history of eczema or asthma in 75 % of the patients. As the name implies, seasonal flare-ups are common, but patients usually have a year-round disease.
The "sine-qua-non" symptom of VKC is itching. Excessive tearing, ropy mucus production, photophobia, burning, foreign body sensation, pain are other common symptoms.
The signs are mostly confined to the conjunctiva and cornea. Eyelid skin and margins are relatively uninvolved compared to atopic keratoconjunctivitis. The "hallmark" finding of VKC is the cobblestone-like giant papillae of the upper tarsal conjunctiva. Bulbar conjunctiva is usually injected and edematous. Especially in heavily pigmented patients limbal changes are prominent. The limbus and perilimbal conjunctiva may be thickened and edematous forming a gelatinous-like hypertrophy. Limbal nodules and Trantas’ dots composed of eosinophils and dead epithelial cells may be observed. Sometimes these limbal changes may result in pannus and superficial neovascularization of the cornea. Most important and vision threatening complications occur in the cornea usually in the form of mild epithelial keratitis or in more severe cases "shield ulcers". The characteristic shield ulcer of the VKC is typically oval or pentagonal, superficial, and superiorly located with grayish opacification of the bed and elevated margins. Shield ulcer results from chemical damage to the epithelial surface by mediators released from mast cells and eosinophils. They are indolent and may take months to re-epithelize. In chronic advanced cases the inflammatory material is deposited in the form of opaque white or yellow "plaque".
In some cases, patients with VKC may resemble those with atopic keratoconjunctivitis (AKC). In AKC the eyelid inflammation and cicatrizing conjunctivitis, especially in the lower fornix leading to symblepharon formation, are pronounced, whereas in VKC these signs are not seen.
The etiology of VKC has been the subject of much speculation. Type I hypersensitivity probably plays a role in VKC, but other mechanisms, particularly type IV hypersensitivity, are also involved. The histopathology of the conjunctival papillae discloses not only the cells typically associated with allergic reaction (mast cells and eosinophils) but also large collections of mononuclear cells, fibroblasts and newly secreted collagen. It has been demonstrated that the conjunctiva of patients with VKC contains T-cell clones which are overwhelmingly CD4+ and secrete IL-4 but not gamma interferon after stimulation therefore being Th2 phenotype.
Although VKC is a self-limited disease, it is debilitating and may be sight threatening. Elimination of the allergens from the environment may be difficult , time consuming, and expensive; but it is a very important aspect in the long term control of the disease. Mast cell stabilizers are the mainstay of the pharmacological treatment. Since these agent have no effect on blocking the effects of released mediators, they should be used prophylactically before exposure to the antigen.
Corticosteroids inhibit phospholipase A2 hence the induction of the arachidonic acid cascade resulting in decreased capillary permeability and cellular exudation, blockage of the influx of leukocytes to the site of injury, and inhibition of fibroblast growth and release of hydrolytic enzymes from inflammatory cells. Topical steroids may be used in the treatment of acute initial disease or to control breakthrough inflammation. But long term therapy should be avoided. Topical and oral NSAIDs may have beneficial additive effects in some patients. Topical cyclosporin 2% solution in olive oil has also been tried with promising results. Since it causes significant irritation and discomfort symptoms, patient compliance may be a problem. In severe vision threatening cases hospital admission and a course of oral steroids may be considered.
ATOPIC KERATOCONJUNCTIVITIS
Michael Hogan described atopic keratoconjunctivitis (AKC) in 1952 as an allergic keratoconjunctivitis occurring in association with allergic dermatitis. The reported incidence of ocular involvement in atopic dermatitis is 25 to 42%.
AKC most frequently occurs in men. It typically presents in the late teen years or early 20s, rarely before puberty, and may persist until the fourth or fifth decade of life. The incidence of AKC peaks in patients between 30-50 years.
Patients commonly complain of extreme itching, burning, and redness. There is usually copious mucous discharge gluing the eyes together upon awakening.
Eyelid disorders are the most common ocular complications of atopic dermatitis. Lids are often red, macerated with crusting and scaling which are not seen in patients with VKC.
Inferior forniceal conjunctiva is most commonly affected leading to symblepharon formation in severe cases. In some cases papillary hypertrophy of the inferior tarsal conjunctiva may occur, again differentiating it from VKC.
Punctate epithelial keratitis is an early corneal finding which may progress into persistent epithelial defects. These defects are often complicated by herpes simplex or staphylococcus aureus superinfections. Neovascularization of the cornea is seen in more severe cases. Keratoconus, retinal detachments and posterior subcapsular cataracts even in the absence of prior steroid treatment may be associated with this condition.
Atopic individuals have a defect in suppressor T cells responsible for regulating IgE production to allergens. Type I hypersensitivity is only one of the mechanisms in the pathogenesis of AKC. Some of the immunopathological characteristics of AKC specimens are similar to those of cicatricial pemphigoid and ocular rosacea emphasizing that fibroblast activation, proliferation and production of cicatrization may result from a variety of chronic conjunctival inflammatory disorders in which T cells, macrophages and mast cells collaborate (22). The histopathologic findings of the conjunctiva of patients with AKC is quite peculiar characterized by mast cell and eosinophil invasion of the epithelium, epithelial pseudotubule formation and increased goblet cell presence. Mast cells and eosinophils along with a chronic mononuclear cell infiltration are also prominent in the substantia propria.
The goals of the treatment are to maintain the visual acuity and relieve patient symptoms. Patients suffer from a systemic disorder with ocular complications. Therefore, help of a clinical allergist and environmental control are the essentials of the management. Topical antihistaminics with vasoconstrictors and NSAIDs may help in relieving the symptoms in mild cases, and in acute excaserbations combined with other medications. Topical mast cell stabilizers are effective in the long term control of the ocular inflammation. Topical steroids may be considered in lid disease or in the case of vision-threatening corneal involvement. But prolonged use is not desirable because of associated side effects. In patients with significant skin findings or asthma, oral antihistaminics and NSAIDs may be used.
Cyclosporin A (CsA) inhibits the clonal expansion of T helper lymphocytes through inhibition of interleukin-2 production. Systemic CsA, 5 mg/Kg/day was found to be highly effective in patients with severe atopic dermatitis. Patients should be monitored closely to detect any systemic side effects.
Secondary cicatricial lid position abnormalities and trichiasis may require special surgical techniques for correction. When corneal scarring is profound, after quieting down the inflammation, visual rehabilitation with a corneal graft may be considered. However, in the post operative period many complications and suboptimal outcomes should be predicted.
GIANT PAPILLARY CONJUNCTIVITIS
Giant papillary conjunctivitis (GPC) is a well known complication of contact lenses, but has also been seen in patients after cataract surgery, ocular prosthesis, extruded scleral buckle, and corneal foreign bodies.
Although originally described as papillae on the upper tarsal conjunctiva 1 mm or larger in diameter, it is now believed that papules 0.3 mm or larger, in association with the symptom complex of itching, contact lens intolerance or conjunctival injection, meet the criteria for the diagnosis of GPC.
Patients complain of lens intolerance, excessive mucous secretion, blurred vision, itching, and ocular irritation. The giant papillae can be best seen after instillation of 2% flourescein into the cul-de-sac and cobalt blue slit lamp illumination. The large papillae in the medial and lateral aspects of the upper tarsus and the ones along the tarsal border should not be used in evaluation as they may be seen in many normal individuals.
Histopathology of the conjunctiva overlying the giant papillae demonstrates thickened and irregular epithelium, with many indippings to the underlying stroma. The epithelium over the atypical portions of the papillae may show localized reduction of the goblet cell population, whereas in the interpapillary crypts, mucus secreting elements seem to be hyperplastic. Keratinization of the upper tarsal conjunctiva has not been observed. Like in VKC or AKC, there are mast cells, eosinophils and basophils in the epithelium and substantia propria of the conjunctiva.
The etiology of the GPC is still not fully understood. Two possible theories include the type IV hypersensitivity reaction against the contact lens material itself, coatings of the lens, or lens solutions, and irritation due to the trauma to the tarsal conjunctiva with release of neutrophil chemotactic factor and other inflammatory mediators. Mostly accepted beief is the combination of the two occurring in the presence of atopic tendency.
Giant papillary conjunctivitis is somewhat less of a problem as it is non-vision-threatening. When the underlying condition is a suture or a foreign body, removal will be enough to improve patients’ symptoms and signs. In contact lens wearers, treatment should be directed firstly to modify the patients’ routine behavior, and often the lens itself. Improving the lens hygiene, finding a better tolerated lens design and material may be useful. Topical mast cell stabilizers have been reported to be helpful in patients with mild to moderate GPC. In severe cases, discontinuation of the lens may be necessary. Steroid use is not recommended because of the chronic nature of the condition.

Eyelid Bumps May Be Associated With Ocular Rosacea

2006-01-11T10:32:00.000-08:00

Chalazion or bumps on eyelids may also be a problem with ocular rosacea. Chalazion is an inflammation of a gland in the upper or lower lid of the eyes. Often the affected area can become swollen, painful and inflamed until a cyst forms. There may be blurring of vision caused by pressure from the cyst distorting the eye.In some cases, it may settle with conservative treatment, which involves hot compresses and antibiotic ointment applied to the affected area.

In persistent cases the chalazion is cut and drained under local anaesthetic, followed by the use of an antibiotic ointment for one week. Recurrent episodes of chalazion are frequently associated with chronic infection of the lid. The infected area should be treated with antibiotic ointment daily for a month or more and cleaning of the eyelid with a cotton bud dipped in warm after and a little baby shampoo.

Refractive Surgery Not Recommened With Ocular Rosacea

2006-01-04T11:50:00.000-08:00

Ocular rosacea (pronounced rose-ay-shah) is a contraindication for all refractive surgery techniques until treated and managed. Even after management, having refractive surgery with ocular rosacea may not be wise because of the possibility of reoccurring outbreaks.
Rosacea is a potentially progressive neurovascular disorder that can present as a combination of skin symptoms including redness of the face, flushing, the presence of small blood vessels ("broken" blood vessels), acne, occasional surface irregularities of the nose (called rhinophyma), and symptoms of redness. Rosacea blood vessels undergo changes in function and become hyper-responsive to internal and external stimuli. These changes are ultimately responsible for the progression of all rosacea symptoms. When it affects the eyes it is called ocular rosacea.
Ocular rosacea can affect both the eye surface and eyelid. Symptoms can include redness, dry eyes, foreign body sensations, sensitivity of the eye surface, burning sensations and eyelid symptoms such as styes, redness, crusting and loss of eyelashes. Ocular rosacea can leave the eyes feeling irritated and "gritty".

The Occurrence Of Ocular Rosacea

2005-12-20T11:44:00.000-08:00

In addition to having unsightly acne-like facial effects, a large percent of rosacea sufferers have eye symptoms. Eighty-nine percent of 2,010 rosacea sufferers responding to the survey indicated that they also experienced discomfort or redness of the eyes in varying degrees. However, of those with eye symptoms, only 27% reported that they had been diagnosed with ocular rosacea. Only 24% said they were treated for the condition.

"Although many people may not connect their eye symptoms with a skin disorder, this is quite common with rosacea and needs to be more widely recognized by the general public and health professionals alike," said Dr. Guy Webster. Webster is associate professor of dermatology at Thomas Jefferson University Medical College in Philadelphia. "Because of the eye symptoms, sometimes an ophthalmologist will be the first to notice rosacea and point the patient to a dermatologist."

Visually, an eye affected by rosacea often appears simply to be watery or bloodshot. Some ocular rosacea patients experience no eye discomfort. But many feel as if there is a foreign body or something gritty in their eyes.

They may also have a dry, burning or stinging sensation.
In severe cases, ocular rosacea may include:
Swollen blood vessels (conjunctival infection)
Inflammation of the eye or eyelid (blepharitis)
Inflammation of the iris (iritis)
Inflammation of the whites of the eyes (episcleritis)
A cyst due to plugging of glands under the eyelids (chalazion)
Loss of vision, in rare instances
A sty-an inflammation of the sebaceous glands of the eyelids-is also common in rosacea sufferers. It is believed to be potentially related to the condition.

"One of the reasons ocular rosacea may often go undetected is the fact that these symptoms tend to develop separately from the facial symptoms of the disorder," Dr. Webster noted. Thirty-eight percent of the survey respondents said their ocular symptoms developed after their facial symptoms. Seventeen percent said their ocular symptoms occurred before facial symptoms. Only 15% reported that their eye and facial symptoms appeared at the same time.
Dr. Webster pointed out that ocular rosacea has been found in up to 58% of rosacea patients in clinical studies. It seems to worsen during the winter months. This may be a result of the frequent gusty winds and cold temperatures.

The good news is that medical therapy appears to be widely effective in improving the symptoms. Of the survey respondents who had been diagnosed and treated for ocular rosacea, 90% said their condition had improved.

Once diagnosed, a physician will usually prescribe a combination of treatments for ocular rosacea tailored to the individual. This may include local and systemic therapy, as well as cleansing and tearing agents, all of which may be adjusted over time. The facial symptoms of rosacea are usually treated with oral and topical antibiotics. This is often followed by long-term therapy with the topical antibiotic alone to maintain remission.

The Diagnosis And Management of Rosacea

2005-12-16T08:23:00.000-08:00

Rosacea is a chronic recurrent inflammatory dermatosis affecting primarily the central areas of the face with ocular involvement in 50 per cent of patients. It is relatively common and it has been estimated to affect approximately 14 million people in the US.
The cause of rosacea has not yet been established. Genetic factors (up to 30 per cent of patients report a family history), environmental, vascular, inflammatory factors, bacteria and micro-organisms such as demodex folliculorum have been considered as possible contributors.
The majority of patients with rosacea are aged between 30 to 60 years old. It affects more women than men. However, males more frequently develop rhinophyma, the swelling and distortion of the nose due to sebaceous gland and connective tissue hyperplasia. The prevalence of rosacea is highest among fair-skinned individuals, especially those of Celtic origin, and is uncommon in dark skinned individuals.
As rosacea affects the face, and because of the common misconception that the development of rosacea may be linked with alcohol abuse, it has a significant psychosocial impact and therefore diagnosis and management are critical.
Clinical features:
The diagnosis of rosacea is based on the clinical features. Symptoms and signs include facial flushing, persistent centrofacial erythema, inflammatory papules and pustules, telangectatic vessels and hypertrophy of the sebaceous glands with fibrosis. Ocular changes can range from mild blepharitis and conjunctivitis through to sight threatening keratitis. Typically, rosacea follows a pattern of remission and exacerbation. There is often an overlapping of clinical features, however, in the majority of patients a particular clinical picture of rosacea dominates. This allows rosacea to be classified into four subtypes: erythematotelangiectatic (subtype 1), papulopustular (subtype 2), phymatous (subtype 3) and ocular (subtype 4). These subtypes are useful in the guidance of therapy. The severity of each subtype can be graded as 1(mild), 2 (moderate) or 3 (severe).
Erythrematotelangiectatic patients have troublesome flushing and persistent central facial erythema. Telangectatic vessels are present. Flushing is exacerbated by spicy foods, alcohol, hot drinks, temperature change, exercise and emotional stress. The differential diagnosis includes lupus erythematosus, chronic actinic damage, and photosensitivity. If flushing is severe carcinoid syndrome, phaeochromocytoma and polycythaemia may need to be considered.
Papulopustular rosacea (subtype 2) is characterised by erythematous dome-shaped papules and small pustules on the central face with a background erythema. Sometimes oedema can occur. In contrast with acne, patients with rosacea do not have comedones (whiteheads and blackheads) and scarring of the skin does not occur.
Phymatous rosacea is subtype 3. It is rare and most commonly seen in men. It results from hyperplasia of the sebaceous glands and connective tissue and is characterised by distorted thickened skin and surface nodules. It is most commonly seen on the nose (rhinophyma).
Ocular rosacea (subtype 4) is common but is frequently overlooked. It has been estimated to be present in 50 per cent of patients with rosacea. Symptoms range from mild irritation to burning and stinging to blurred vision. Patients can have blepharoconjunctivitis, chalaia, hordeola, and very rarely keratitis, with potential visual loss.
Management:
There is no cure for rosacea. Management includes avoidance of exacerbating factors, medications to suppress the inflammatory lesions and the use of surgery or laser therapy for phymatous disease and telangectasias. Treatment is guided by the predominant subtype of rosacea the patient has.
Patients with rosacea have sensitive skin, so mild cleansers and emollients are advised. All patients with rosacea should apply sunscreens daily to prevent the development of facial photodamage that will exacerbate the redness of rosacea. Patients should attempt to identify aggravating factors to flushing and avoid these, and be advised that effective cosmetic coverage can neutralise erythema. Accurate patient information can be accessed via groups such as the National Rosacea Society () and American Academy of Dermatology () that have websites.
Erythematotelangectatic rosacea is difficult to treat. Where telangiectatic vessels are significant pulsed dye laser therapy, which causes selective photothermolysis, can be employed. This results in coagulation of the superficial vessels without associated dermal damage.
Topical and systemic antibiotics are the principal treatments for papulopustular rosacea. Topical metronidazole is both antibacterial and anti-inflammatory, and application twice daily results in less erythema and a reduction in inflammatory lesions. Topical metronidazole should be used with caution in women of child bearing age who are not taking oral contraception as it potentially can be absorbed and has mutagenic side effects.
Sodium sulfacetamide (antibacterial) and sulfur (keratolytic) topically can be used. Azelaic acid (antibacterial, anti-inflammatory) top- ically is comparable in efficacy to topical metronidazole. Topical erythromycin (antibacterial; anti-inflammatory) is another effective therapy.
Systemic agents, with or without concurrent topical treatment, are indicated in moderate to severe (grades 2 and 3) papulopustular rosacea.
Systemic agents such as oxytetracycline, doxycycline, erythromycin and minocycline, are most frequently used. Treatment should be for four to 12 weeks. Once systemic treatments are ceased, topical therapy is then continued to maintain a remission.
Rhinophyma is uncommon. Grades 2 and 3 rhinophyma can be effectively treated with surgical excision, electrosurgery or CO2 – laser therapy.
Ocular rosacea is common and usually mild. It is treated with good eyelid hygiene and warm compresses, artificial tears and topical application of metronidazole gel to the eyelid margins. Grades 2 and 3 may require treatment with systemic antibiotics. Referral to an ophthalmologist should be made if symptoms are persistent or severe.
Summary:
• Rosacea is a common condition with a significant psychosocial impact.
• Rosacea can be classified into subtypes which guide effective therapy.
• All patients should apply sunscreen daily and, where possible, avoid exacerbating factors.
• Erythematotelangiectatic rosacea is best managed with sun protection and possibly carbon dioxide laser treatment for prominent telangectasias.
• Papulopustular rosacea is usually treated with topical agents and/or systemic antibiotics.
• Phymatous rosacea is uncommon. Effective therapies include surgery and laser therapy.
• Ocular rosacea can be managed with eyelid hygiene, artificial tears and topical metronidazole. Persistent or severe symptoms should prompt referral to an ophthalmologist.
• Patient can access accurate information on websites such as the National Rosacea Society or the American Academy of Dermatology .

Dr Maeve McAleer, Dermatology Senior House Officer, Regional Centre of Dermatology, Mater Misericordiae University Hospital, Dublin

Ocular Rosacea Often Overlooked

2005-12-13T09:22:00.000-08:00

Ocular rosacea (subtype 4) is common but is frequently overlooked. It has been estimated to be present in 50 per cent of patients with rosacea. Symptoms range from mild irritation to burning and stinging to blurred vision. Patients can have blepharoconjunctivitis, chalaia, hordeola, and very rarely keratitis, with potential visual loss.

Ocular rosacea is common and usually mild. It is treated with good eyelid hygiene and warm compresses, artificial tears and topical application of metronidazole gel to the eyelid margins. Grades 2 and 3 may require treatment with systemic antibiotics. Referral to an ophthalmologist should be made if symptoms are persistent or severe.

Ocular Rosacea's Effect on Sight

2005-12-01T11:00:00.000-08:00

While red, teary or scratchy eyes might sometimes be shrugged off as simple irritation from harsh winter weather, these may actually be warning signs of ocular rosacea, a potentially serious condition that many people do not associate with a skin disorder.
"The effects of rosacea on the eyes may easily be overlooked because they often develop after, and sometimes before, the disorder affects the skin," said Dr. Bryan Sires, associate professor and acting chair of ophthalmology at the University of Washington. "In most cases, ocular rosacea is a mild, irritating condition, but it can develop into a permanently debilitating one -- including loss of vision -- without proper care."
Although as many as 58 percent of rosacea patients have been found to have ocular symptoms in clinical studies, he noted that the condition may be easily controlled if diagnosed and treated before it becomes severe.
An eye affected by rosacea often appears to be watery or bloodshot. Patients may feel a gritty or foreign body sensation in the eye, or have a dry, burning or stinging sensation.
Dr. Sires added that in the majority of ocular rosacea patients, beyond mild irritation there is a feeling of fullness in the eyelid. This is often the result of thickened secretions of the meibomian or Zeis glands along the eyelid margin. The fatty secretions help to avoid evaporation of the watery layer of the tears. The plugging of these glands may lead to dry eye or styes, both common manifestations of ocular rosacea.
"Severe symptoms result when the cornea becomes infected," he said. "These patients have a deep boring pain. At this point, an aggressive treatment approach is necessary to avoid the need for a more invasive procedure like corneal transplantation."
Left untreated, patients with severe ocular rosacea could endure scarring within the eyelid, vision loss from corneal ulcers and potential loss of the eye if an ulcer progresses beyond the cornea.
Ocular rosacea is diagnosed by an overall examination of both the facial skin and eyes. Ophthalmologists also frequently use a biomicroscope, which allows the detection of tiny visible blood vessels along the eyelid margin and any plugging of the meibomian glands -- both signs of ocular rosacea.
Treatment for ocular rosacea is typically a combination of local and systemic therapy as well as cleansing and tearing agents, all of which may be adjusted over time.
For mild cases, patients are often instructed to use warm compresses several times a day on the eyelids. Lid hygiene may include gentle cleansing with a Q-Tip and baby shampoo. For moderate cases, topical medications may be prescribed, along with eye drops for lubrication.
"For more severe cases, patients are placed on oral antibiotics such as doxycycline," Dr. Sires said. "This is at regular doses for a two-week period and then at a maintenance dose for several months thereafter."
As with facial rosacea, ocular rosacea patients are also encouraged to identify and avoid any lifestyle or environmental factors that may trigger or aggravate their individual condition. Common trigger factors include emotional stress, hot or cold weather, wind, spicy food, alcohol, heated beverages and many others.

Subtypes Of Rosacea

2005-11-29T09:46:00.000-08:00

Four subtypes of rosacea have been identified. A patient may have one or more subtypes. Subtype 1 (erythematotelangiectatic rosacea) causes flushing and persistent redness. Some patients may also have visible blood vessels near the surface of the skin. Subtype 2 (papulopustular rosacea) leads to persistent redness and transient appearance of bumps and pimples. Subtype 3 (phymatous rosacea) causes a thickening of the skin, like an enlargement of the end of the nose. Subtype 4 (ocular rosacea) is characterized by the presence of eye problems, like dry eye, burning and tearing, swollen eyelids, and potential corneal damage and loss of vision.

Simply Ocular Rosacea

2005-11-16T08:15:00.000-08:00

In all simplicity, ocular rosacea is a combination of dry eye and ocular inflammation. Surprisingly, relieving the dry eye symptoms usually results in substantial improvement of ocular rosacea.

One of the main complaints that occular rosacea sufferers complainof is blurry vision. In 99% of the cases this actually has nothingto do with vision loss. It has to do with a disturbance in the three layers of moisture on your eye surface (mucus, water and oil).

This(and sometimes the inflammation) plays a role. Good treatment focuses on getting back a normal tear film layer first, then seeing what happens.

ARTIFICIAL TEARS are one of the best things you can do for your eyes.While treatment for ocular rosacea is usually multifactorial, several studies have shown that daily use of artificial tears for three to four months can help the tear film stabilize by decreasing ocular irritation.

Then patients can sometimes stop immediately or just use them upon flare ups. PLEASE DON'T USE VASO-CONSTRICTOR EYEDROPS!

The challenge is to find the right eye drop for your eye. The eye vessels in general are a lot more forgiving then the facial vessels.

Many folks recommend Refresh Plus Drops for Sensitive Eyes. I have found great success with Thera Tears eye drops, which are preservative free.

In many cases, the normal eye drops are not strong enough. That is why the leaders in the industry have made gel drops. Several of these gel drops by themselves have been shown to improve the entire tear film layer, stabilize the water concentration and electrolyte balance, and reduce some forms of inflammation. Gels last 4 to 8 times longer than most normal eye drops.

Some of the newer versions of gel drops worth a try are:
1. GenTeal Eye Gel Carbopol 980 gel. This is the strongest gel drop. For flat out moisturization without blurriness.
2. Bausch and Lomb Liquid Gel Hypromellose gel.
3. Systane hydroxypropyl guar. This is the newest gel derivative and there is quite a bit of information on pubmed about the guaractions.

Many like the Similasan I and II drops. For those with severe dry eye, the Lacriserts placed under the eyelid at night still have no match.

Another good topical for ocular rosacea is an ointment calledLacrilubeby Allergan. It is kind of thick and sticky so you won't really be able to use it during the day. It definitely makes your eyes feel better, especially when they have that foreign body sensation or irritation. You put it directly in the pocket of your eyes.

If the inflammation is still severe, Doxycycline 100 mgs 2 to 4 times a day can be used or Periostat 40 mgs. If this fails, then the mast cell inhibitor Patanol is always a good try.

Two new eye drops/suspensions continue to show promise for moderate to severe ocular rosacea.
1. 10% N-acetylcysteine drops (Mucomyst) -- This mucolyticagentcan be used successfully in rosacea patients with abnormal tear film layer (mucus layer). In ocular rosacea, the superficial inflammationcan alter goblet cells, which affects the production of the tear film layer. This is the first agent to address this specific problem.

2. Cyclosporine ophthalmic (Restasis) drops -- Used to relieve dry eyes caused by suppressed tear production secondary to ocular inflammation. First eye drop to actually increase natural tear production, stabilizetear film layer and resolve ocular inflammation. Restasis eye drops are available by prescription. It can take up to 3 months to see their full effect.

Oral cyclosporine can cause a number of side effects. Topical cyclosporine (restasis) should be used cautiously in moderate to severe occular rosacea patients, but it is generally much safer to use. Medical studies indicate it may be used safely long term 6 to 9 monthswith a low side effect profile. In many patients, it relieves the inflammation and therefore stops the tear film layer from breaking up.

Regarding rosacea, it specifically blocks several classes of inflammatory cytokines on the ocular surface, which this makes the ocular surface more "healthy". If you decide to start the eye drops, follow up with your doctor and get ocular surface testing every 3 to 6 months.

Ocular Rosacea And Allergies

2005-11-14T06:41:00.000-08:00

Obviously, there is a great degree of overlap with eye symptoms from allergies. It is very wise to see an eye specialist. They will run a thorough series of tests to determine the most probable cause of your symptoms, and the physician should give you some effective treatment options.

Description of Ocular Rosacea

2005-11-12T08:11:00.000-08:00

Ocular rosacea is a disorder that affects both the eye surface and eyelid. Some of the most common symptoms include:
• Bloodshot eyes
• Burning sensations
• Eye pain
• Foreign body sensations of the eye surface
• Excess tearing of the eye
• Hyper-sensitivity of the eye surface
• Eye irritation to wind, cold, smoke, indoor heating
• Photophobia (pain and tearing of the eyes triggered by bright light).
• Itching of the eye surface• Redness, crusting, and inflammation of the eyelids. In some cases, crust may form overnight that `glues' the eyelids together.
• Chalazia (inflammatory bump on the eyelid)
• Stye (inflammation of an eyelash follicle)
• Excess discharge from the sebaceous glands of the eyelids.
• Loss of eyelashes
• Severe damage to the cornea and blindness

Understanding Dry Eye Syndrome

2005-11-11T08:46:00.000-08:00

The dry eye syndrome is a chronic insufficiency of moisture in the eye. Its consequences range from subtle but constant irritation to severe disturbance in day-to-day activity.
Its symptoms may include the following:
*A stinging, burning or scratchy sensation in your eyes.
*A sense of a sand grain in your eyes.
*Strings of mucus in or around your eyes.
*Eye fatigue after short periods of reading.
*Feel better with eyes closed.
The dry eye syndrome has several causes. For some people the cause is an imbalance in the composition of their tears. In others its insufficient tears to keep the eyes comfortably lubricated. Medications and environmental factors can also lead to dry eyes.
The common causes include:
1. Living in a dry, dusty or windy climate.
2. As a part of the natural aging process, especially during menopause.
3. As a side-effect of many medications such as antihistamines, antidepressants, certain blood pressure medicines and birth control pills.
4. Insufficient blinking such as when you’re staring at a computer screen all day.
5. Dry eyes are also a symptom of systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren’s syndrome.
6. Long-term contact lens wear is another cause.
7. Certain conditions may cause eyes to feel dry and scratchy, like in blepharitis, an inflammation along the edge of the eyelids.
Treatment
For most people who have dry eyes, it’s a chronic condition. The goal of treatment is to make the symptoms as less as possible.
Effective treatment begins with a careful examination to determine which factors may be causing your symptoms. The goal of treatment is to keep your eyes moist. This can be done in a couple of ways:
Artificial tears: These are lubricating eye drops that may reduce the dry, scratching feeling.
Preserving tears: This can be done by partially or completely closing the tear ducts, which normally serve to drain tears away. The closure conserves both your own tears and artificial tears you may have added.
Medications: Dry eyes caused by problems with the meibomian glands and blepharitis generally respond to specific treatment for the same.
Self-care
Simple care at home can make these patients feel better. So,
*Avoid direct air currents. Don’t direct hair dryers, car heaters, airconditioners or fans toward your eyes.
*Wear protective glasses while going out.
*Use home humidifiers. In winter, a humidifier can add moisture to dry indoor air. Some people use specially designed glasses that form a moisture chamber around the eye, creating additional humidity.
*Remember to blink. While working on computers, consciously blink. It helps spread your own tears more evenly.
*Avoid rubbing your eyes.
*Cold compresses give soothing feeling to the patient with dry eyes.

Dr Mahipal S. Sachdev

Ocular Dermatitis

2005-11-08T09:40:00.000-08:00

Ocular or eyelid dermatitis can result when someone touches or rubs her eyes with polished nails, transferring the toluene-sulfonamide-formaldehyde resin in the polish to highly sensitive skin.

Are Blue Eyes More Prone To Ocular Rosacea?

2005-11-04T12:02:00.000-08:00

Are blue eyes more sensitive to irritation and sunlight? Probably not, according to Dr. Brian Pazzo, an ophthalmologist at NewYork-Presbyterian/Weill Cornell hospital."

First, as far as I know, color does not determine if the eyes become irritated easily," Pazzo said. "Some people with allergies, either ocular or full-body, tend to be very irritated by pollen, dust or dryness, and the irritation exists regardless of eye color."

As to the second question, Pazzo said, "In terms of light sensitivity, which is also called photophobia, light-colored eyes, like light-colored skin, have less of the pigment melanin and are probably more susceptible to the harmful effects of the sun, like certain types of eye cancer, but I know of no good long-term studies that demonstrate that blue eyes are more sensitive to light."Pazzo said that he had seen hundreds of cases of blepharitis, or inflammation of the eyelid, and rosacea, a skin irritation that can affect the eye area, and that from what he had observed, the irritation was more related to skin color than to eye color.

The iris is the colored part of the eye, while the pupil in the middle determines how much light gets to the back of the eyeball."

Oftentimes people with light-colored eyes have larger pupils," Pazzo said, but added, "In thousands of patients and colleagues, I have never seen reports that light-colored eyes are more sensitive to light."

Two Types of Blepharitis

2005-11-02T09:26:00.000-08:00

The eyes are so precious that it's especially important to make sure that minor problems don't grow into major ones. After reading this column, I recommend that you consider consulting the doctor you saw before, or an ophthalmologist.
Blepharitis is one of the most common problems of the eyes. It is inflammation of the margins of the eyelid. It often lasts for a long time and often recurs. It's inconvenient and unattractive but not usually destructive. Occasionally, however, it can cause loss of eyelashes and damage to the eye itself.
There are two types of blepharitis, anterior and posterior. Both are common. Anterior blepharitis usually involves the eyelid, eyelashes and surrounding glands. It can be caused by a staph infection or seborrheic dermatitis of the scalp, brows or ears. Recent studies have found large numbers of a parasite called demodex in people with blepharitis. But the majority of people with this parasite do not have the condition.
Posterior blepharitis is an inflammation of the back of the eyelid, usually resulting from a problem with the sebaceous glands that secrete oil in the area. It is also associated with acne rosacea.
In addition to seborrhea and rosacea, other diseases that may cause blepharitis are lupus erythematosus, Sjogren's and Crohn's disease. It's important to look for symptoms of these diseases when evaluating someone with blepharitis.
Blepharitis stubbornly resists treatment. Available treatment often does not fully cure this condition but rather is directed at getting it under control and fighting flare-ups.
The main approach to treatment is twice-daily cleaning of the eyelids and application of warm compresses. Commercial eyelid scrubs are available and may be easier to use, but baby shampoo has been a mainstay of treatment for a long time.
Antibiotic ointments may be helpful when applied daily to the lid margins. If the eye surface itself becomes infected, oral antibiotics may be required. It is a good idea to sample the secretions on the eye to test for microorganisms and their sensitivity to antibiotics.
Topical steroids may help some people treat their blepharitis. But prolonged use of these medications may result in other eye problems. So, if steroids are used, it's important to discuss with the prescribing physician how often and how long to use them. Please discuss and write down the potential problems that may occur and what to do immediately if that happens.
I recommend that you talk with a doctor about all of the things that you've tried and what effect, if any, they have had. To make this much easier and more effective, write the information down before seeing the doctor and hand it to her or him at the beginning of your appointment.

Ocular Rosacea: Article by J Bradley Randleman, MD

2005-10-31T10:00:00.000-08:00

Rosacea is a dermatologic condition that affects the midfacial region (in the form of telangiectasias, erythema, papules and pustules, and rhinophyma). More than 50% of patients with rosacea have ocular manifestations. No correlation exists between the severity of ocular disease and the severity of facial rosacea.

Ocular manifestations are essentially confined to the eyelids and ocular surface. Problems range from minor irritation to potentially severe ocular surface disruption and inflammatory keratitis. Sight-threatening disease is rare with rosacea; however, keratitis can result in sterile corneal ulceration and eventual perforation if not treated aggressively.

The symptoms of rosacea can be treated effectively; however, rosacea is a chronic condition with exacerbations and remissions, which requires long-term therapy to maintain symptomatic control.

The precise pathophysiology of rosacea remains unknown. Rosacea manifests itself primarily as a cutaneous vascular disorder; however, inflammatory changes are a hallmark of severe rosacea. Thus, rather than a specific disease entity, rosacea may be thought of as a disease spectrum with 2 primary etiologic components, vascular and inflammatory. The earliest manifestations of the disease are cutaneous vascular dilatory changes with subsequent increased blood flow in the form of telangiectasias and erythema. Sunlight-induced small vessel damage may contribute to this underlying vascular instability.

The later stages of rosacea are marked by inflammatory changes in the form of papules and pustules in the midface, rhinophyma (bullous nose), blepharitis and meibomitis, and corneal vascularization. A type 4, cell-mediated hypersensitivity reaction has been hypothesized as a possible mechanism. Demodex mites also have been implicated as a possible inflammatory stimulus. Additionally, Helicobacter pylori has been postulated to be a causative factor in a subset of patients. Whatever the underlying mechanism, there is a fundamental abnormality in the sebaceous glands of the face and eyelids, which leads to the inflammatory changes exhibited.
In the US: More than 10% of the general population exhibits dermatologic characteristics of rosacea; of these, up to 60% experience ocular complications.

Read complete article at: http://www.emedicine.com/OPH/topic115.htm

The Dry Eye of Ocular Rosacea

2005-10-23T09:55:00.000-07:00

Ocular Rosacea and Iritis

2005-10-21T11:56:00.000-07:00

Iritis is an inflammation of the iris, a part of the eye. Symptoms include eye pain, sensitivity to light, and/or blurry vision. The symptoms of this may resemble conjunctivitis.
Sties can also occur in ocular rosacea. The best treatment for a stye is a warm compress. Apply a warm, moist washcloth to your lids for 5 minutes, four times a day. Following this treatment, within a few days the infection will either die down or come to a head and drain.

OCULAR ROSACEA AND THE KERATITIS CONNECTION

2005-10-19T08:43:00.000-07:00

BLEPHARITIS

2005-10-17T04:51:00.000-07:00

Blepharitis is a common inflammatory ocular condition that affects the eyelids. It usually causes burning, itching and irritation of the lids. Other common symptoms include sandy, itchy eyes, red and/or swollen eyelids, crusty, flaky skin on the eyelids, and dandruff. In severe cases, this ocular condition may also cause sties, irritation and inflammation of the cornea (keratitis) and conjunctiva (conjunctivitis). Some patients have no ocular symptoms at all. Blepharitis, usually a chronic problem, can be controlled with extra attention to lid hygiene. However, it may also be caused by an infection which would require treatment with a prescription medication.

The key to controlling blepharitis is to keep the eyelids and eyelashes clean. Home treatment should begin by soaking a clean washcloth in hot tap water. Place the compress on closed eyelids for five minutes, and then repeat. Next, gently scrub the eyelids with a washcloth or cotton swab soaked in a mixture of equal parts of baby shampoo and water. Afterward, rinse the lids thoroughly with warm water.

This treatment may need to be repeated two to three times daily for two weeks, and then reduced to once daily. Like dandruff, there is no cure for blepharitis; but with treatment, it can be controlled. Anti-inflammatory and antibiotic treatment drops or ointments may be necessary for flare-ups or more severe cases. Remember to remove all mascara before going to bed.
Red, painful eyes may be the result of conditions known as episcleritis and scleritis. Both conditions involve inflamed blood vessels in the eye.

The Blood-Shot Eyes Of Ocular Rosacea

2005-10-14T10:06:00.000-07:00

Ocular rosacea patients generally have chronically "bloodshot" eyes, dry eyes, and blepharitis (inflammation and debris of the eyelid margins). In severe ocular rosacea, there may be corneal ulceration (infection) which, if untreated, may even lead to perforation of the eye. This can be a potentially blinding complication.
People with rosacea have a tendency to be overall more dehydrated than others. The body is approximately 65% water while the eye is 96% water. Increasing your water intake will increase the moisture in the eye (thereby decreasing irritation and dryness). It has been found that increasing the amount of water consumed daily can ease the symptoms of ocular rosacea for many.

Half of Rosacea Sufferers Affected by Ocular Rosacea

2005-10-12T05:58:00.000-07:00

Ocular Rosacea Defined

2005-10-09T11:45:00.000-07:00

RED EYED AND RED FACED

2005-10-07T06:48:00.000-07:00

Rosacea guru to end battle over critics' site
By Kevin Corcorankevin.corcoran@indystar.com

A Fishers physiologist whose online postings turned him into a guru for people suffering from rosacea agreed Thursday to abandon his legal fight to silence a Web site questioning his credentials and advice.

Published anonymously, the site claims Geoffrey Nase, 36, is practicing medicine without a license and dispensing potentially harmful advice to many thousands of people desperately seeking a cure for the tough-to-treat inflammatory skin disease.

Nase -- who has made claims about himself that Indiana medical groups have refuted -- unmasked his cybercritics, and Thursday he tried to confront them in Marion Superior Court.After several hours of attorneys for the Web site operators and Nase shuttling in and out of Judge Kenneth Johnson's office, both sides said they had reached an agreement in principle.
Nase's attorney, Vincent Perez, described it as a confidential settlement.

However, Ronald J. Waicukauski, the attorney for the out-of-state Web site operators, said his clients would continue to maintain their online presence and that Nase agreed to drop his lawsuit by Jan. 31.

In court filings, Nase claims his online rosacea critics slandered him, interfered in his business pursuits and dried up sales of his self-published, 332-page book on the incurable and progressive acnelike disease. He had asked Johnson to order the Web site shut down immediately.Nase has stated he filed the suit in mid-August to defend his reputation.

The case would have required Johnson to balance the critics' First Amendment rights against the potential harm to Nase's Internet business prospects.

The defendants -- Dr. Nicholas Soldo, an anesthesiologist from Scottsdale, Ariz., who uses lasers to treat rosacea, and one of Soldo's former patients, Laura Thomas, Asheville, N.C. -- say they can back up claims that Nase has inflated his credentials and dispensed harmful advice.Both attended what was supposed to be a full-blown evidentiary hearing Thursday."

Under no circumstances was that Web site coming down," Soldo said after the closed-door settlement talks. "It's too important to the rosacea community."

Online, the flare-ups between Nase and his critics have been dubbed the "Rosacea Wars" or "Nase wars" because of the way the caustic exchanges have roiled chat boards devoted to the disease.

Johnson said he did an online search during the settlement talks he initiated and found at least 10 pages of back-and-forth."I said, 'Geez, you guys have been really, really busy,' " Johnson said.

Nase estimates he has personally posted 55,000 individual messages touting rosacea research and offering free advice to sufferers within the past nine years. In addition, he ships his self-published paperback, "Beating Rosacea: Vascular, Ocular & Acne Forms," directly from his office for $46.90 plus shipping and handling, according to Amazon.com.Nase has a doctoral degree in microvascular physiology from West Virginia University's School of Medicine. Nase runs an online site called "drnase.com" for rosacea sufferers looking for alternative treatments.

Waicukauski told the court Nase "has ruthlessly attacked virtually anyone who disagrees with him." Soldo and Thomas are both ex-supporters of Nase who created the "DebunkingNase" Web site to challenge Nase's various claims.

They say they began to have doubts about him after he told his online supporters of a series of medical calamities this spring that included five gastrointestinal surgeries, the loss of 45 percent of his blood, heart attacks, major brain surgeries and a blood infection.

Yet, they say, Nase soon was back online. He even claimed to have done a business deal while in a coma.During a deposition Sept. 30, Nase refused to answer questions about his medical treatment. He asked Johnson to block access to his medical records.

Thomas said she began checking other online claims Nase had made and uncovered inconsistencies in his background.

For instance, Nase has stated that "after detailed interviews and evaluation," Indiana's Medical Licensing Board had "granted Dr. Geoffrey Nase full privileges to offer in-depth consultations to rosacea sufferers." However, Michael Rinebold, the board's director, said Nase's claim is false.

Nase also has stated the Indiana State Medical Association gave him approval to call himself a rosacea specialist, to consult with patients over the Internet and to dispense medical advice. "I can tell you point-blank that is a bold-faced lie," said Adele Lash, the association's spokeswoman.

Nase did not return a call to his home Thursday seeking comment after the settlement was reached.

He has said his critics launched their Internet site after learning that he would be partnering with a dermatologist in Portland, Ore., who offers laser treatments for rosacea that would compete with Dr. Soldo's national practice. Nase received $6,000 a month for referring people to the Oregon clinic -- a financial tie that critics say he failed to disclose.

Nase's online detractors say the arrangement -- and his decision to seek damages against the "DebunkingNase" site operators for lost income -- ran counter to online assertions that he has "never ever made a single penny for anything related to rosacea."

Ocular Rosacea And The Blepharitis Connection

2005-10-03T11:49:00.000-07:00

Blepharitis is a common inflammatory ocular condition that affects the eyelids. It usually causes burning, itching and irritation of the lids. Other common symptoms include sandy, itchy eyes, red and/or swollen eyelids, crusty, flaky skin on the eyelids, and dandruff. In severe cases, this ocular condition may also cause sties, irritation and inflammation of the cornea (keratitis) and conjunctiva (conjunctivitis). Some patients have no ocular symptoms at all. Blepharitis, usually a chronic problem, can be controlled with extra attention to lid hygiene. However, it may also be caused by an infection which would require treatment with a prescription medication.
The key to controlling blepharitis is to keep the eyelids and eyelashes clean. Home treatment should begin by soaking a clean washcloth in hot tap water. Place the compress on closed eyelids for five minutes, and then repeat. Next, gently scrub the eyelids with a washcloth or cotton swab soaked in a mixture of equal parts of baby shampoo and water. Afterward, rinse the lids thoroughly with warm water.
This treatment may need to be repeated two to three times daily for two weeks, and then reduced to once daily. Like dandruff, there is no cure for blepharitis; but with treatment, it can be controlled. Anti-inflammatory and antibiotic treatment drops or ointments may be necessary for flare-ups or more severe cases. Remember to remove all mascara before going to bed.
Red, painful eyes may be the result of conditions known as episcleritis and scleritis. Both conditions involve inflamed blood vessels in the eye.

Ocular Rosacea May Cause a Dry Eye Syndrome

2005-09-30T08:30:00.000-07:00

Eye Treatment of Ocular Rosacea

2005-09-28T08:36:00.000-07:00

A View of Ocular Rosacea

2005-09-23T05:56:00.000-07:00

Sources of Additional Information on Ocular Rosacea

2005-09-20T01:03:00.000-07:00

Additional Information on ocular rosacea can be found at the following:
Eye and Skin Disease by Mannis, Macsai, and Huntley, ch 41. A very detailed medical coverage of Rosacea including a very comprehensive discussion of Ocular Rosacea.
Ocular Rosacea : American Family Physician
Keratitis on Spedex.Com. More Keratitis information from the University of Michigan.
Iritis Information on Iritis.Org
Blepharitis Information from Merck and from Cecille G. Taylor MD
Episcleritis description
Article about chalazia
Ocular rosacea and treatment

Ocular Rosacea Symptoms

2005-09-15T08:28:00.000-07:00

Symptoms of ocular rosacea include dry eyes or tearing, redness, burning, pain or a feeling that something is in the eye - perhaps a gritty feeling. (Jenkins 1979). Also, scales and crusts on the eyelids, sensitivity to light and blurry vision
Specific conditions include:
Inflammation of eyelashes or lid margins, the generic term for which is blepharitis. Blepharitis often results in red, itchy, burning eyes and lashes as well as scales and crusts on the eyelids. Included in this group of conditions are sties which are infections of eyelash follicles. Other conditions include an enlarged / inflamed or plugged meibomian gland (the gland which lubricates the eyelids) which is called chalazia or meibomitis. Problems with the meibomian gland may result in dry eyes
Red, painful eyes may be the result of conditions known as episcleritis and scleritis. Both conditions involve inflamed blood vessels in the eye.
Keratitis is one of the more serious conditions which may occur in relation to ocular rosacea. Keratitis is a term which is used to a range of conditions where there is infection or inflammation of the cornea. This condition may result in severe eye pain, blurry vision and sensitivity to light. Medical evaluation and treatment of keratits is absolutely essential.
iritis - Inflammation of the iris, a part of the eye. Symptoms include eye pain, sensitivity to light, and/or blurry vision. The symptoms of this may resemble conjunctivitis.

Ocular Manifestations of Rosacea

2005-09-11T10:46:00.000-07:00

Ocular Rosacea Treatment Options

2005-09-08T04:50:00.000-07:00

As can be implied by the number and variety of treatment options available for rosacea, no one therapeutic regimen has been found effective in all cases, and many cases of rosacea are recalcitrant to multiple therapies. Therefore, treatment always must be tailored to each individual, and various options must be explored until symptoms begin to respond favorably.
Lid hygiene: Hot compresses applied to the eyelid margins can help to liquefy the thick meibomian gland secretions and, thus, facilitate their expression. Mild, nonirritating cleaning solutions, such as dilute baby shampoo or commercially prepared eyelid scrubs, also can be applied to the eyelids to remove clogging debris. Additionally, light pressure applied to the eyelids can aid in gland expression.
Artificial tears: Because of the frequency of application, nonpreserved artificial tears are recommended for use. Tears should be applied liberally throughout the day, and, if necessary, a lubricating ointment may be used at night. This ointment may contain an antibiotic preparation.
Antibiotics (Patients with ocular rosacea who are asymptomatic and without worsening eye disease should not be placed on oral antibiotics.)
Tetracyclines (tetracycline, doxycycline, minocycline)
Tetracyclines represent the most common and most effective treatment regimen for rosacea. These drugs are believed to be effective not primarily as antibiotics but rather through a secondary effect that they exert on the meibomian glands. Tetracyclines decrease bacterial lipase, thereby altering the fatty acid composition of the meibomian gland secretions and improving their solubility. These medications also inhibit collagenase; therefore, they are effective in protecting the cornea from impending perforation secondary to inflammatory responses.
Adverse effects are predominantly gastrointestinal, including diarrhea and rarely pancreatitis and pseudomembranous colitis. More severe but much less common adverse effects include benign intracranial hypertension and renal tubular damage (Fanconi syndrome) from outdated medications. Additionally, tetracyclines cross the placenta and can cause permanent discoloration of teeth as well as retardation of fetal bone growth.
Tetracyclines generally are effective for rosacea in doses much lower than those given for antibiotic effect, and, once the disease has come under control, the dose may be tapered to a lower, suppressive dose and maintained indefinitely. Due to the chronic, relapsing nature of rosacea, the medication may be used chronically at suppressive doses or discontinued and restarted if and when symptoms recur.
Among this class of medications, tetracycline and doxycycline most commonly are used. The 2 medications are quite similar in their mechanism of action, side effect profile, and efficacy, but slight differences do exist. Tetracycline has a shorter half-life and, thus, is dosed 4 times per day, as opposed to doxycycline, which is given twice per day or once per day. Frucht-Pery et al reported a more rapid therapeutic response to tetracycline; however, no difference was found at 6 months. Additionally, the side effects profile is slightly more favorable for doxycycline.
Erythromycin can be taken orally for patients intolerant to, or too young for, tetracyclines. Erythromycin ointment applied to the lid margins once or twice daily can provide lubrication for the eye and reduce the bacterial overgrowth contributing to lid margin disease.
Clarithromycin has shown efficacy in treating rosacea. This compound exhibits anti-inflammatory effects as well as activity against H pylori. Torresani compared clarithromycin and doxycycline and found equivalent therapeutic responses and a milder side effect profile for clarithromycin.
Metronidazole
Metronidazole exhibits antimicrobial (antibacterial and antiparasitic), anti-inflammatory, and immunosuppressive properties and has been found effective against rosacea. Oral metronidazole has in fact been advocated as first-line therapy. Adverse effects include gastrointestinal irritation and a disulfiramlike action; thus, abstinence from alcohol is required.
Topical metronidazole is quite effective in treating skin lesions in rosacea. While not approved for ophthalmic use, in a pilot study, Barnhorst et al found the topical compound to be safe and effective in treating eyelid involvement in ocular rosacea.
Topical steroids can prove useful for short-term exacerbations of lid disease and management of inflammatory keratitis. However, steroids should be used cautiously and discontinued as soon as possible to prevent corneal melting.
Retinoids: Vitamin A derivatives, such as oral isotretinoin and topical tretinoin, have been found effective in reducing the inflammatory lesions in rosacea. This appears to be accomplished via the suppression of sebum production and a subsequent reduction in sebaceous follicle size. Additionally, tretinoin may help restore sun-damaged skin through the increased production of type 1 collagen in damaged regions. Both compounds actually can cause severe erythema and blepharoconjunctivitis, worsen telangiectasias, and lead to severe keratitis. Additionally, retinoids are extremely teratogenic and, thus, must never be used during pregnancy. Therefore, the use of retinoids commonly is reserved for cases in which multiple agents have failed.
Antiulcer therapy: H pylori plays an as yet undetermined role in rosacea, and some have advocated H pylori eradication in treatment of rosacea. Thus, in some cases of rosacea, antiulcer combination regimens, such as amoxicillin or clarithromycin, metronidazole, bismuth, and an H2 antagonist have been used with varying efficacy.

Surgical Treatment of Ocular Rosacea

2005-09-05T08:12:00.000-07:00

Surgical treatments for ocular rosacea include:
Treatment of dry eye: Punctal occlusion can be accomplished via permanent silicone plugs or punctal cauterization.
Treatment of corneal perforations
Cyanoacrylate tissue adhesive
Lamellar keratoplasty
Penetrating keratoplasty
Restoration of vision from corneal disease
Penetrating keratoplasty
The success rate for graft survival generally is much lower than for noninflammatory conditions due to the increased vascularization of the host cornea.

The Facts on Ocular Rosacea

2005-09-02T12:52:00.000-07:00

Ocular rosacea is a term used to describe the spectrum of eye findings associated with the skin involvement. Ocular involvement may include meibomian gland dysfunction and/or chronic staphylococcal lid disease, recurrent chalazia, chronic conjunctivitis, peripheral corneal neovascularization, marginal corneal infiltrates with or without ulceration, episcleritis and iritis. Occasionally, the ocular manifestations may precede skin involvement, delaying the diagnosis.

Rosacea occurs most commonly in adult life, between the ages of 30 and 60 years. It may also be found in children, although rarely. In a series of 47 patients with ocular rosacea, the decade of prevalence was 51-60 years. Ocular involvement occurs in more than 50% of patients. Women have been traditionally considered to be affected with twice the frequency of men, although some data suggests that the distribution between men and women is equal. Cases with ocular manifestations are about evenly divided between the sexes or show only a small female preponderance. The distribution of cases by age in the two sexes is similar. Both acne rosacea and ocular rosacea have been documented in blacks. Increased pigmentation in the black population may mask the early lesions of rosacea, accounting for previous failure to recognize the disease in the black population. There is a wide-spread clinical impression that rosacea mainly affects fair-skinned people of northern European descent or Celtic origin. However, studies have not substantiated this assumption.

Ocular Rosacea Requires Special Care

2005-08-28T12:35:00.000-07:00

Red eyes often go hand in hand with red faces for many people with rosacea, as many develop the ocular form of the disorder in addition to facial symptoms. Fortunately, the effects of ocular rosacea can be successfully controlled with medical help and appropriate eye care.
In a recent National Rosacea Society survey, 61 percent of nearly 1,400 respondents said they had suffered eye symptoms such as a watery or bloodshot appearance, a gritty feeling, or burning or itching.
"Ocular rosacea is often overlooked because it may develop separately from the facial signs and symptoms of the disorder," said Dr. Guy Webster, professor of dermatology at Thomas Jefferson University Medical College. "Specific treatment for this condition may be essential, and a daily eye care routine can also reduce discomfort."
Visually, an eye affected by rosacea often appears simply watery or bloodshot. Some patients may feel as though there is something in their eyes, or have a dry, burning or stinging sensation. In severe cases, ocular rosacea may include swollen blood vessels; inflammation of the eyelid, iris or the whites of the eyes; sties or cysts, and in severe cases even loss of vision.
Physicians usually treat ocular rosacea with oral antibiotics and other therapies. In addition, a number of steps can be taken to help soothe and prevent irritation and discomfort.
Clean carefully the area surrounding the eye. Just as with a facial care routine, daily eye care starts with removing all eye makeup, using a gentle, non-abrasive cleanser and rinsing with lukewarm water several times to make sure the eye area is completely clean. Blot dry gently with a soft cotton towel. After the eye area air-dries for a few moments, use a gentle moisturizer on the lids and underneath the eyes.
Ask your doctor about using a tearing agent. If eye dryness or a gritty feeling is a problem, talk to the doctor about using a special agent to moisten the eyes. Preservative-free artificial tears applied several times a day can help eliminate that dry, gritty feeling. Do not use any over-the-counter products for red or irritated eyes unless the doctor recommends it.
Apply warm compresses and gently massage the eyelids. Not only will this feel refreshing, but massaging the eyelids will help loosen any debris in the tear glands and stimulate circulation. This can be especially soothing after a long day at work, or being outside in the cold and wind.
Wear UV sunglasses outdoors. They protect your eyes from harmful rays of the sun, and act as a shield against wind and other elements. Sunglasses without UV protection may actually make the condition worse.
If you have facial rosacea and are now having problems with your eyes, ask your doctor whether you should see an ophthalmologist.

Can Ocular Rosacea Result In Blindness?

2005-08-24T21:48:00.000-07:00

from harsh winter weather, these may actually be warning signs of ocular rosacea, a potentially serious condition that many people do not associate with a skin disorder.
"The effects of rosacea on the eyes may easily be overlooked because they often develop after, and sometimes before, the disorder affects the skin," said Dr. Bryan Sires, associate professor and acting chair of ophthalmology at the University of Washington. "In most cases, ocular rosacea is a mild, irritating condition, but it can develop into a permanently debilitating one -- including loss of vision -- without proper care."
Although as many as 58 percent of rosacea patients have been found to have ocular symptoms in clinical studies, he noted that the condition may be easily controlled if diagnosed and treated before it becomes severe.
An eye affected by rosacea often appears to be watery or bloodshot. Patients may feel a gritty or foreign body sensation in the eye, or have a dry, burning or stinging sensation.
Dr. Sires added that in the majority of ocular rosacea patients, beyond mild irritation there is a feeling of fullness in the eyelid. This is often the result of thickened secretions of the meibomian or Zeis glands along the eyelid margin. The fatty secretions help to avoid evaporation of the watery layer of the tears. The plugging of these glands may lead to dry eye or styes, both common manifestations of ocular rosacea.
"Severe symptoms result when the cornea becomes infected," he said. "These patients have a deep boring pain. At this point, an aggressive treatment approach is necessary to avoid the need for a more invasive procedure like corneal transplantation."
Left untreated, patients with severe ocular rosacea could endure scarring within the eyelid, vision loss from corneal ulcers and potential loss of the eye if an ulcer progresses beyond the cornea.
Ocular rosacea is diagnosed by an overall examination of both the facial skin and eyes. Ophthalmologists also frequently use a biomicroscope, which allows the detection of tiny visible blood vessels along the eyelid margin and any plugging of the meibomian glands -- both signs of ocular rosacea.
Treatment for ocular rosacea is typically a combination of local and systemic therapy as well as cleansing and tearing agents, all of which may be adjusted over time.
For mild cases, patients are often instructed to use warm compresses several times a day on the eyelids. Lid hygiene may include gentle cleansing with a Q-Tip and baby shampoo. For moderate cases, topical medications may be prescribed, along with eye drops for lubrication.
"For more severe cases, patients are placed on oral antibiotics such as doxycycline," Dr. Sires said. "This is at regular doses for a two-week period and then at a maintenance dose for several months thereafter."
As with facial rosacea, ocular rosacea patients are also encouraged to identify and avoid any lifestyle or environmental factors that may trigger or aggravate their individual condition. Common trigger factors include emotional stress, hot or cold weather, wind, spicy food, alcohol, heated beverages and many others.

The Most Common Effects of Ocular Rosacea

2005-08-21T18:55:00.000-07:00

A recent study by researchers at the University of California, Davis identified the most common eye effects of subtype 4 (ocular) rosacea found by ophthalmologists during patient examinations.1
In the study of 88 ocular rosacea patients, 85 percent had meibomian gland dysfunction. These glands secrete a fatty substance that helps keep the eye from drying out, and plugging of these glands may result in dry eye or styes.
Other common physical effects included tiny visible blood vessels or redness on the eyelid, found in 53 percent of the patients; blepharitis, an inflammation of the eyelid, found in 44 percent; and bloodshot eyes, seen in 41 percent.
Among more severe potential manifestations of ocular rosacea, corneal scarring was found in 16 percent of the patients and corneal neovascularization (the development of additional blood vessels in the cornea) was found in 11 percent. Both conditions may result in loss of vision or visual acuity.
"Although ocular rosacea is usually an irritating but mild condition that can be treated, without proper care it can become seriously debilitating," said Dr. Mark Mannis, chairman of ophthalmology at the University of California, Davis. Patients who experience signs and symptoms of ocular rosacea should be sure to address them with their physicians.

Rosaceans Tears May Hold Key To Ocular Involvement

2005-08-17T10:59:00.000-07:00

Preliminary data from a study funded by the National Rosacea Society have found that the tears of rosacea patients contain different proteins than the tears of people without rosacea. The results point to the potential for a screening test for ocular rosacea in the future.
The study, "Tear Proteins in Patients with Rosacea," is being conducted by a team led by Dr. Mark J. Mannis, chairman of the Department of Ophthalmology at the University of California - Davis.
Tears were collected from 17 rosacea patients and 22 normal controls. The researchers analyzed proteins called mucopolysaccharides in the tears of each group, and identified a distinct pattern in the type and quantity of certain proteins in the rosacea patients' tears that differed from those of the controls.
"This is a very significant finding," said Dr. Mannis. "If our initial results are validated by more extensive research, this may lead to the identification of a diagnostic test -- heretofore illusive to investigators."

Ocular Rosacea And Contacts

2005-08-13T12:30:00.000-07:00

Anyone with ocular rosacea should consult their physician about the safety of wearing contact lenses in their particular case. Depending on the individual, the symptoms of ocular rosacea may make wearing contact lenses problematic.
Common symptoms may include watery or bloodshot eyes, foreign body sensation, burning or stinging, dryness, itching and light sensitivity. Blepharitis, where the eyelids are red and swollen and have dried crusts, and chalazion, a small sebaceous cyst of the eyelid, may also occur. However, the good news is that with appropriate treatment, symptoms of ocular rosacea may be brought under control.

Treatment of Ocular Rosacea With Laser

2005-08-10T13:25:00.000-07:00

Ocular rosacea (pronounced rose-ay-shah) is a contraindication for all refractive surgery techniques until treated and managed. Even after management, having refractive surgery with ocular rosacea may not be wise because of the possibility of reoccurring outbreaks.

Rosacea is a potentially progressive neurovascular disorder that can present as a combination of skin symptoms including redness of the face, flushing, the presence of small blood vessels ("broken" blood vessels), acne, occasional surface irregularities of the nose (called rhinophyma), and symptoms of redness. Rosacea blood vessels undergo changes in function and become hyper-responsive to internal and external stimuli. These changes are ultimately responsible for the progression of all rosacea symptoms. When it affects the eyes it is called ocular rosacea.
Ocular rosacea can affect both the eye surface and eyelid. Symptoms can include redness, dry eyes, foreign body sensations, sensitivity of the eye surface, burning sensations and eyelid symptoms such as styes, redness, crusting and loss of eyelashes. Ocular rosacea can leave the eyes feeling irritated and "gritty".

Treating Ocular Rosacea With Eye Drops

2005-08-07T16:06:00.000-07:00

There are four new eye drops now available to rosacea sufferers for ocular rosacea. These do much more than just lubricate the eyes.They actually treat some of the underlying pathology.

1. Cyclosporine Eye Drops – these drops have been out for about ayear. For moderate to severe inflammatory ocular rosacea, there isno better treatment.
2. Castor Oil Eye Drops – For unknown reasons high concentrationcastor oil eye drops are very effective for generalizedmeibomianitis (inflammation of the oil glands in the eyelids)
3. Medroxyprogesterone Acetate Eye Drops -- Very Effective forocular rosacea caused or made worse by menopause.
4. Dehydroepiandrosterone (DHEA) Eye Drops – The newest treatment.Decreased androgens in the tear film layer has many negativeactions. Addition of certain androgens reverses many symptoms.

Will these new treatments be effective? Only time and clinical trials will tell.

Treating Ocular Rosacea

2005-08-05T16:53:00.000-07:00

Oral tetracycline and doxycycline effectively control the ocular symptoms of rosacea; these are the only agents that have been rigorously studied in the treatment of ocular rosacea. A short course of topical corticosteroid solution may be useful for symptomatic relief of ocular rosacea; however, ocular steroid therapy should be initiated and managed by an ophthalmologist because experience with this treatment is limited. Liquid tears are useful for dry eyes and relief of ocular itching. Low-dose treatment with oral isotretinoin (10 mg, three times weekly for two to three months) has also been successful in recalcitrant ocular rosacea.