Ocular Rosacea

From EyeWiki
Original article contributed by: Lei Jiang, MD
All contributors: Lei Jiang, MD and Linda Rose, MD, PhD
Assigned editor: Linda Rose, MD, PhD
Review: Assigned status Up to Date by Linda Rose, MD, PhD on August 28, 2015.
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Disease Entity[edit | edit source]

Rosacea is a chronic inflammatory acneiform skin condition that leads to erythema of the skin on the face and neck.  It can frequently involve the eyes with studies showing ocular involvement in 6 to 58% of patients . It is characterized by a malar rash, which can include papules and pustules on the face and neck.  The hallmarks of ocular rosacea include bilateral chronic blephatritis, and meibomian gland dysfunction. At the slit lamp, eyelid margin telangiectasia, and inspissation of the meibomian glands are seen. Patients frequently develop evaporative dry eye. Some patients develop recurrent chalazia. Symptomatically patients may complain of burning and foreign body sensation.  Left untreated, recurrent episodes can lead to peripheral corneal ulceration, corneal scarring and neovascularization.  

Pathophysiology[edit | edit source]

Rosacea is thought to be an inflammatory condition without an definitive etiology.  It is thought to represent a type IV hypersensitivity reaction. Possible sources of inflammation include bacterial lipase action on free fatty acids, elevated levels of interleukin alpha, demodex mites and vascular incompetence.  It can be exacerbated by consumption of alcohol and coffee because of their vasodilatory effects.  

Clinical Presentation[edit | edit source]

Rosacea is characterized by excessive sebum secretion.  Most frequently found in patients 30-60 years old and is up to three times more common in Women.  Patients can clinically present with telangiectasias of the eyelid margin, recurrent chalazia, facial pustles, conjunctival injection, papules and erythema of cheeks, forehead, and nose.  Rhinophyma of the nose can occur as a late finding.  Corneal findings include neovascularization, stromal scarring, and in severe cases, corneal perforation.  

Differential diagnosis[edit | edit source]

Lupus erythematosus

Herpes simplex keratitis

seborrheic dermatitis

Management[edit | edit source]

Systemic tetracyclines are thought to decrease inflammation associated with rosacea and are often first line agents for patient's with moderate disease. More recently shorter duration pulse therapy with Azithromycin pulses have been found effective. Dietary supplements containing Omega-3 fatty acids have been found to improve meibomina gland dysfuntion.  Topical metronidazole can be used to treat facial lesions.  Other immunosuppressive therapies such as topical steroids and topical cyclosporine may be helpful in reducing chronic eyelid and corneal inflammation.  Warm compresses and lid hygeine may also improve symptoms.   Interventional office treatments include Lipiflow, and the use of Intense Pulse Light therapy.

References
[edit | edit source]

Stone DU, Chodosh J.  Ocular rosacea: an update on pathogenesis and therapy.  Curr Opin Ophthalmol. 2004;15(6):499-502

AAO Basic and Clinical Science Course, External Disease and Cornea, 2010-2011, 69-70.