Since doing hot compresses can't sleep at night

[bernmee]

I checked that out but there is no definition of Ocular Rosacea.

I guess I'm just confused about the extent of the connection between ocular rosacea, blephitis and MGD, and how it applies to me.

I guess that will be one for my new Dr.

Might as well have him working for his money

[NYer]

Good Information About Ocular Rosacea

You're right - the "Dry Eye Encyclopedia" does not contain anything about Rosacea. The following is long but it contains a lot of info about Ocular Rosacea that is much-needed here. It is from www.internationalrosaceafoundation.org. That site contains a lot of info about Rosacea in general (mostly facial) and is worth checking out, but this part is specific to Ocular Rosacea.

Ocular Rosacea

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.

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.

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).

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.

Blepharitis is a common inflammatory ocular rosacea 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.

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.

Iritis another common aspect of ocular rosacea, 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 (also known as "pink eye").

Sties can also occur in ocular rosacea. The best thing for a stye 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.

Chalazia, Chalazian or bumps on eyelids may also be a problem with ocular rosacea. Hot packs are the best treatment for these infections, also. However, if the bump fails to go away in a month it may be necessary to drain it. This is done in your Ophthalmologist's office.

There is no optimum standard treatment for ocular rosacea, but communication between the dermatologist and ophthalmologist is a healthy step toward ward determining a correct diagnosis and an appropriate course of care for the ocular condition.

One of the concerns in ocular rosacea is the possibility of secondary infection, since a dry environment is a good breeding ground for bacteria like staphylococci.

In the majority of instances, when patients have ocular rosacea, it presents with generalized rosacea, says Mark Mannis, M.D., an ophthalmologist and professor and chairman of the department of ophthalmology and vision science at the University of California, Davis, in Davis, Calif. In about 20 percent of cases, it presents with significant ocular disease and very mild skin disease.

"Even though it's clearly a dermatologic disease, patients will present to the ophthalmologist rather than the dermatologist in those instances," says Dr. Mannis, who describes ocular rosacea as chronic more than recurrent.

"If the patient presents with only ocular findings, then the rosacea is difficult to diagnose," Dr. Mannis says. "It's a skin disease, but can have serious ocular side effects, from chronic irritation to potentially being a blinding disease."

Protocols to treat the disease from an ophthalmology standpoint do not differ greatly from what dermatologists offer. Systemic tetracyclines are the mainstay. These drugs act multifactorially by decreasing bacterial flora and the expression of matrix metalloproteinases, altering meibum secretion, inhibiting the production of bacterial lipases and providing an immunomodulatory effect, Dr. Mannis explains.

Ocular rosacea therapy is aimed at preventing irritation of the ocular surface and controlling inflammation with topical and systemic anti-inflammatory drugs, Dr. Mannis adds. However, ophthalmologists may use short courses of topical steroids for an acute situation of ocular rosacea.

"When patients present with severe ocular rosacea, it usually takes about four to six weeks for the systemic therapy to work adequately," Dr. Mannis says. "One can at least relieve the ocular symptoms in the short term using topical steroids."

For prolonged treatment, Dr. Mannis says ophthalmologists offer topical nonsteroidal anti-inflammatory agents as an adjunct to systemic therapy.

If a delayed diagnosis occurs, permanent changes develop in the architecture of the eyelid, Dr. Mannis explains. In addition, significant corneal damage can occur if a diagnosis is delayed. In the most severe cases, corneal scarring, corneal vascularization, corneal perforation and even blindness can occur with severe chronic inflammation.

"A timely diagnosis is very important for long-term ocular health," he says. "It's a disease that you want to get under control, because a person could potentially lose vision from it in the more severe cases. Any patient with rosacea who has ocular irritation, light sensitivity and a decrease in visual acuity or obvious inflammation of the lids or conjunctiva should be referred to an ophthalmologist."

Significant tear dysfunction or blepharitis can also occur with ocular rosacea, Dr. Mannis notes. If a symptom like blepharitis does occur with ocular rosacea, ophthalmological surgeries such as photorefractive keratectomy or LASIK, both designed to correct vision, would be contraindicated in those patients. More invasive surgery like cataract surgery would also be potentially complicated. "We feel that these patients would benefit from early intervention of their eye disease," Dr. Mannis says.

Dr. Mannis is performing laboratory research to identify markers to diagnose ocular rosacea, particularly in instances when the skin symptoms are minimal and a diagnosis is challenging. "We are looking for a diagnostic test, because it's difficult to make the diagnosis when the skin signs are minimal," he says. "We are looking for a marker in the tear film to identify patients with rosacea."

Dr. Mannis and colleagues published a study in 2005 in the Journal of Proteome Research in which they concluded, in a sample of 37 patients, that there was an abundance of specific oligosaccharides in the tear fluid of patients with rosacea, suggesting the potential for an objective diagnostic marker for the disease.

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.

Ocular rosacea is characterized by dry, red eyes. It can occur in isolation or as part of generalized rosacea, says Alan Shalita, M.D., distinguished teaching professor and chair in the department of dermatology at SUNY Downstate Medical Center, Brooklyn, New York.

"I have stayed away from treating the condition with steroids because of a rebound phenomenon. The use of steroids can make things worse, particularly if patients have used topical steroids over the long term," Dr. Shalita tells Dermatology Times.

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.

[bernmee]

NYer,

Thanks for that, I had been looking at another Rosacea site and just wasn't getting that level of information.

Here is a link to another site I was looking at http://www.agingeye.net/otheragingeye/blepharitis.php

I am getting from this site that MGD is a form of blephitis, posterior rather then anterior. That would mean that blephitis is the "mommy" so to speak of a couple of conditions depending on your symptoms?

I'm going have a good look at that rosacea website, I'm on Doxy right now so I want to be good and prepared for when I come off it.

Thanks for the info.

B.

[NYer]

Haha, yeah, Blepharitis is the Mommy of MGD (especially if you look at that flowchart on that site) but I don't think it's the Mommy of Rosacea. I think Rosacea is just what some of us have, unfortunately. And if you have Rosacea, you are probably prone to Blepharitis and MGD.

Of course, having rosacea makes us fair-skinned beauties who blush ever so femininely.

(That is, so long as no one minds looking at our red eyes).

By the way, I can't tolerate doxycycline. It gave me acid reflux. I hope you do better on it.

[bernmee]

Thanks for taht.

I now have all my defintions and the family tree in place. Makes it easier to know what you should be reading, and how to talk to the Dr. at those ever expensive appointments.

I understand also that rosacea is out there by itself. I seem to be doing well after 12 days on Doxy, no reactions. I got myself a good pro biotoc today though as three months is a long time to be taking something, though I know it could end up being longer.

Thankfully I don't have red eyes but my red face is a little more then blushing, think sweaty looking and you got it

Thanks for all the help in getting this sorted out.

Now I will move myself over to that rosacea wite and surf between the two when I should be working.

B.

[NYer]

I started another thread about ocular rosacea that you might want to check out. I got some new answers from Dr. Latkany about some of the questions here.

http://www.dryeyezone.com/talk/showthread.php?t=6698