Rosacea ocular

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 03.03.2023

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Synonym(s)

Eye Rosacea; ocular rosacea; Ophthalmorosacea; Ophthalmo-Rosacea; Opthalmorosacea

Definition
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Chronic inflammatory eye involvement of the rosacea symptom complex, which may or may not be accompanied by skin changes. In about 20% of rosacea patients, this symptomatology is a harbinger of rosacea. In 25 to 50% of affected individuals, ocular rosacea occurs concurrently with skin symptoms.

Occurrence/Epidemiology
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Ocular rosacea is observed in about 20% (6-18% according to other authors) of patients with skin symptoms. In primary ocular rosacea, skin lesions are absent or only discretely developed. This form can already occur in childhood.

Manifestation
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Corresponds to the age of manifestation of rosacea (about 80% of patients are over 30 years old). In about 20% of patients the ocular symptoms appear with a time lag of several years to the skin changes.

Indication for natural remedies
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Euphrasia officinalis(eyebright)-containing eye drops (WALA Euphrasia®).

Clinical features
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The clinical symptoms are accompanied by redness and inflammation of the lid margin and the tarsal and bulbar conjunctiva (blepharitis, conjunctivitis sicca). Furthermore, foreign body or dryness sensation, burning sensation and increased lacrimation are reported. Not infrequently, these symptoms are associated with eyelid edema or even edema of the periorbital region.

Severe forms are associated with disturbances of the tear film and visual disturbances (sensitivity to light, blurred vision).

An unfavorable prognosis applies to rosacea ceratitis, since it can lead to ulceration, possibly to perforation and blindness.

Note: There is no correlation between the severity of cutaneous rosacea and the extent of ocular symptomatology. In rare cases, isolated involvement may occur, making it difficult to assign to rosacea.

Differential diagnosis
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Bacterial, viral (e.g. Herpes simplex virus) or allergic conjunctivitis.

Complication(s)
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In ocular rosacea, the risk of chalazion (hailstones) or conjunctivitis is increased. As a consequence of chronic blepharoconjunctivitis , corneal ulcers may occur in combination with corneal vascular neoplasms.

General therapy
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Interdisciplinary dermatologic-ophthalmologic therapy approach: The therapy of the disease includes on the one hand a local treatment of the eyelid changes directly, as well as a general treatment of the underlying disease. Standard measures today are:

Eyelid warming and cleansing: By warming the eyelids for at least 4-5 minutes, the fatty secretion of the meibomian glands is liquefied and can thus be massaged out of the eyelids. It is important that the heating is done efficiently and that the massage of the eyelids is done according to the course of the glands towards the eye (upper eyelid from top to bottom, lower eyelid from bottom to top). Remove crusty coatings from the eyelid edges with the help of e.g. vegetable oils, physiological saline solution or boiled water and cotton swabs. The procedure should be performed 2x/day for a period of > 3 months.

Antibiotics: Antibiotics (tetracyclines, acythromycin, etc.) are useful not only for obvious infection, but also for chronic non-infectious course due to additional anti-inflammatory and fat liquefying mechanisms of action. Efficacy has been demonstrated especially for systemically applied tetracycline derivatives. This therapy must also be used for at least 3 months to achieve sustained improvement.

Note: Patients with ocular rosacea should refrain from using isotretinoin, as this may worsen ocular symptoms (dryness symptoms).

Anti-inflammatory drugs: Glucocorticoid-containing eye drops and ointments are used in cases of severe inflammatory changes. These almost always lead to rapid improvement during use, but also to recurrences after discontinuation. Due to side effects of permanent use (cataract or glaucoma), glucocorticoid externals to the eye should only be used temporarily. Alternative: e.g. ciclosporin eye drops in suitable carrier systems (NRF formulation) .

Tearsubstitutes: Tear substitutes can be used for symptomatic relief of the discomfort of the often concomitant dry eye. Of the many available preparations, an unpreserved preparation should be used when used more than 2-3 times daily (hyaluronic acid-containing tear substitute: GenTeal, Hyalo-Vision. Carbomer-containing tear drops: Thilo-Tears®; Nature: Euphrasia officinalis (eyebright)-containing eye drops (WALA Euphrasia)).

Internal therapy
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Tetracyclines: Efficacy has been demonstrated, particularly for systemically applied tetracycline derivatives. The drug of choice is doxycycline. Alternatively, minocycline is recommended. This therapy must also be used for at least 3 months to achieve a sustained improvement in the situation. Permanently, 50mg doxycycline every 2nd day is sufficient to suppress ocular inflammation.

Note: Patients with ocular rosacea should refrain from using isotretinoin as it may worsen ocular symptoms (dryness symptoms).

Literature
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  1. Awais M et al,(2015) Rosacea - the ophthalmic perspective. Cutan ocul toxicol 34:161-166.
  2. Oltz M et al.(2011) Rosacea and its ocular manifestations. Optometry 82:92-103.
  3. Stone DU et al(2004) Ocular rosacea: an update on pathogenesis and therapy. Curr Opin Ophthalmol 15:499-502.
  4. Vieira AC e al. (2013) Ocular rosacea: common and commonly missed. J Am Acad Dermatol 69(6 Suppl 1):S36-41.
  5. Webster G (2013) Ocular rosacea: a dermatological perspective. J Am Acad Dermatol 69(6 Suppl 1):S42-43.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 03.03.2023