Ocular Rosacea: Everything You Need To Know
The painful rosacea subtype that affects your eyes
If you have ocular rosacea, you will know all too well how infuriating and upsetting a condition it can be to live with. I’ve written a few versions of this blog post over the years, but I wanted to move it over to Substack so I can keep updating it. As always, I’ve consulted an expert to help me with the medical side of this article - I asked Mr Alex Day, Consultant Ophthalmologist, to help me with this topic. Whether you’re newly diagnosed with ocular rosacea or are a long-time sufferer, hopefully this post will offer some help.
Mr Alex Day is a Consultant Ophthalmologist and you can find more information about him HERE. I’m so grateful for his generous help with this post. For clarity, I have included all of his quotes in italics, anything in regular font is written by me. If you have any general questions about ocular rosacea that you don’t believe are covered here, please let me know and I’ll try to get the answers for you.
WHAT IS OCULAR ROSACEA?
Ocular rosacea is an inflammatory condition that affects the eyes. It’s similar in appearance and feeling to other eye irritations, which is why it’s often not linked to the accompanying - more well-known - rosacea subtypes.
It is often referred to as rosacea subtype 4, although subtype classifications are falling out of favour with those who know a lot about rosacea, as I covered in THIS POST.
WHAT ARE OCULAR ROSACEA SYMPTOMS?
The main symptoms of ocular rosacea are: dry-feeling eyes, irritation or burning, watery or bloodshot appearance (telangiectasia), swollen and inflamed eyelids (blepharitis), styes, sensitivity to light, crusting around the lashes, loss of eyelashes/misdirected eyelashes, and a gritty sensation as though there’s a foreign object in the eye.
HOW COMMON IS OCULAR ROSACEA?
[A reminder that any text in italics is a quote from Mr Alex Day, anything in regular text is written by me]
“Ocular rosacea is a relatively common manifestation of rosacea and typically affects around 50% of those with the condition. Early diagnosis and prompt treatment are crucial to preserving ocular health and maintaining visual function.”
Additional information from the National Rosacea Society: It is believed to affect men and women equally, is most likely to start after age 30, and is most common in people over the age of 50.
WHAT CAUSES OCULAR ROSACEA?
“Ocular rosacea shares similar underlying causes with cutaneous rosacea [note from Lex: cutaneous just means related to the skin, so in a conversation about ocular rosacea it’s a way to differentiate between the types], primarily involving a combination of genetic predisposition, environmental factors, and immune system dysregulation.”
“The exact cause is still not fully understood, but factors such as abnormal function of the oil glands in the eyelids, overgrowth of certain bacteria, or the presence of demodex mites on the eyelashes and a heightened inflammatory response appear to play key roles. Additionally, environmental triggers like sunlight, wind, temperature extremes, spicy foods, alcohol, and stress can exacerbate symptoms. Dysfunction of the tear film and abnormalities in the eyelid margin also contribute to ocular surface inflammation.”
A fascinating study of ocular rosacea patients discovered that “85 percent had meibomian gland dysfunction. The meibomian glands line the edge of the eyelid and secrete a fatty substance that helps keep the eye from drying out. Plugging of these glands may result in dry eye, styes or chalazions (a type of benign cyst).”
For this reason, ocular rosacea is sometimes referred to as Meibomian Gland Dysfunction (MGD). You can read all about the study HERE, including information on how ocular rosacea can worsen and affect overall eye health and eyesight. There are also theories about the differences in glycans (a type of molecule in tears and saliva) between rosacea patients and non-sufferers.
ARE SOME PEOPLE MORE LIKELY TO DEVELOP OCULAR ROSACEA?
“There are certain individuals who are more predisposed to developing ocular rosacea. Genetic factors play a significant role, with a family history of rosacea increasing the likelihood of developing the condition. Additionally, fair-skinned individuals of northern European descent are at higher risk. Other risk factors include being female, age over 30 and having a history of cutaneous rosacea.
Individuals with certain systemic conditions such as diabetes, inflammatory bowl disease or hormonal imbalances may also have an increased susceptibility to ocular rosacea.”
IS IT LINKED TO ANY OTHER ROSACEA SUBTYPES?
“Ocular rosacea is closely linked to other subtypes of rosacea. Many individuals with ocular rosacea also experience symptoms on the skin, such as facial flushing, redness, papules, and pustules.
In fact, ocular rosacea is considered a manifestation of the systemic inflammatory disorder that affects the skin. Additionally, ocular rosacea shares similar underlying mechanisms with cutaneous rosacea, including abnormal immune responses, dysfunction of the skin’s barrier function, and alterations in the skin microbiome. The two conditions often coexist and can exacerbate each other’s symptoms.”
ARE MOST DOCTORS AWARE OF OCULAR ROSACEA? SHOULD I BRING IT UP AT MY APPOINTMENT?
“Ocular rosacea is generally well-known among the medical community, especially among dermatologists and ophthalmologists. However, its recognition and diagnosis may vary among healthcare providers in different specialties.
While some doctors may proactively inquire about ocular symptoms in patients with rosacea, it is important that patients mention any eye issues such as eye redness, irritation, or dryness. It is often helpful if they keep a diary of their symptoms to help their doctor understand how these affect their lifestyle.”
If you would like to track your symptoms prior to your appointment, I have designed a digital download that you can get for free HERE – you can print it off, fill it in, and take it to your appointment to make sure you remember everything you wanted to cover.
IS OCULAR ROSACEA PROGRESSIVE? WHAT ARE THE DANGERS IF LEFT UNTREATED?
“Ocular rosacea is typically a mild disorder, although there is potential for more severe complications if it is left untreated or inadequately managed. The progression of ocular rosacea varies among individuals: some may experience mild symptoms that remain stable over time, while others may develop more severe manifestations requiring prompt treatment.
Early diagnosis and prompt intervention are crucial in preventing progression and minimising long-term complications. With appropriate management, including lifestyle modifications, topical and oral medications, and regular monitoring, the progression of ocular rosacea can often be halted or slowed, helping to preserve ocular health and vision.”
HOW CAN THE SYMPTOMS BE MINIMISED/MANAGED BY THE PATIENT?
“There are definitely some actions that can be put into place to help minimise/manage the symptoms. The aim of all of these medical interventions is to control inflammation, manage symptoms, prevent complications, and preserve ocular health and vision. Treatment plans are customised based on the specific manifestations and severity of the condition.
The management of ocular rosacea typically involves a multidisciplinary approach with dermatologists and ophthalmologists, focusing on controlling inflammation, managing symptoms, and preventing complications. Regular follow-up visits are important to monitor response to treatment and adjust management as needed.
Please see tips below:
Regular cleansing of the eyelids with warm water and mild baby shampoo or eyelid wipes can help reduce inflammation and remove debris and bacteria. Tea tree eyelid scrubs have particularly been found to be helpful in reducing inflammation and improving vision.
Lubricating eye drops or ointments can alleviate dryness and discomfort associated with ocular rosacea.
Identifying and avoiding triggers such as sunlight, wind, temperature extremes, spicy foods, alcohol, and stress can help prevent symptom exacerbation.
Devices such as warm compresses for eyelid warming masks can improve oil gland function and alleviate symptoms of blepharitis.
Some studies suggest that supplementation with omega-3 fatty acids (flaxseed or fish oil supplements) may help reduce inflammation and improve symptoms in ocular rosacea.
Wearing sunglasses with UV protection and avoiding contact lens wear during flare-ups can protect the eyes from environmental irritants.”
WHAT ARE THE MEDICAL INTERVENTIONS FOR OCULAR ROSACEA?
“Prescription medications such as steroid eye drops or topical cyclosporine or azithromycin, an antibiotic, may be used to control inflammation and manage symptoms.
Oral antibiotics such as doxycycline are commonly prescribed, although these need to be taken for 6-12 weeks, and sometimes long-term maintenance treatment is needed for disease control.
Punctal plugs are tiny devices inserted into the tear ducts to block the drainage of the tears, thereby helping to retain moisture on the ocular surface. They can be helpful in managing ocular rosacea by reducing dry eye symptoms and improving tear film stability. Punctal plugs can be either temporary, and made of collagen which dissolves over a few months, or permanent made of silicone.
For severe dry eye, a scleral contact lens can be used. These are large, rigid contact lenses that vault over the cornea and rest on the sclera (white part of the eye). They create a fluid reservoir between the lens and the cornea, providing constant lubrication and protection to the ocular surface.
Ocular IPL (Intense Pulsed Light). This involves the use of intense pulsed light to target blood vessels and inflammation on the eyelids. It can help alleviate symptoms associated with ocular rosacea, such as skin redness and visible blood vessels. Typically, 3-5 treatment sessions are needed with maintenance treatments every 6 months to 2 years.
Radiofrequency eye treatment is a non-invasive procedure that uses radiofrequency energy to generate heat when applied to the skin. This reduces eyelid inflammation and skin redness in ocular rosacea.
Please note: While these are all possible treatment options, individuals with ocular rosacea need to consult with an experienced eye care specialist to determine the most appropriate treatment plan tailored to their specific needs and symptoms.”
FURTHER OCULAR ROSACEA TIPS (from Lex)
Here are my personal tips, some of which are mentioned above, but I wanted to give a little bit more information and some recommendations from my personal experience. Links may be affiliate, which means if you buy using my link I get a small percentage of the sale at no extra cost to you.
👁️ Try to include Omega-3 in your diet
Omega-3 is thought to help with dry eye symptoms, so including it in your diet every week is a really great idea. If you have no idea where to start, this information page from Heart UK is really useful. Luckily I flipping love oily fish so it’s not a chore for me to eat it, and I also add flaxseed to my morning smoothie (I get this one). If you can’t get Omega-3 into your diet through diet, have a look at supplements like these ones from Boots.
👁️ Give your eyes regular breaks
I work on screens all day and really notice that my eyes are more sore if I don’t give myself breaks. Try to have complete breaks from screens for at least 5 minutes every hour – that means laptops and phones, tablets etc. I was also told by my ophthalmologist that I don’t blink properly (I didn’t believe it either!) when I’m concentrating, so the bottom half of my eyes are more dry than the top half. So when I give myself screen breaks, I try to have a good blinking session (a phrase I never thought I would have to type but here we are…)
👁️ Protect your eyes from extreme weather
UV-protected sunglasses (on sunny and/or windy days) and wide-brimmed hats/caps will really help with streaming and sore eyes. You may have seen my UV umbrella from my Japan photos last year: it’s a lifesaver if you find yourself squinting all the time (plus it’s obviously great for protecting you from the sun in general) – you can get the umbrella HERE.
👁️ Use eye drops
I have eye drops in my handbag so that I can calm that horrible itching feeling as soon as it starts. THESE are great.
👁️ Use skincare designed for sensitive eyes
As people with rosacea, it’s unlikely we’re using skincare products with fragrance or high levels of actives but just in case, these are not suitable for your delicate eye area.
I don’t necessarily believe that you need a separate eye cream if you feel like your moisturiser is light and gentle enough to go all over your eyes, however if you are looking for a separate product, I really like the cooling gel feel of THIS one from Clinique, which will last you forever because you only need the tiniest amount.
👁️ Use make-up designed for sensitive eyes
I’m going to do a blog post on the specifics of this, but my main tip is to find eye make-up that firstly doesn’t irritate your sensitive eyes, but secondly doesn’t budge when your eyes are streaming.
Tubing mascara is a really clever invention as the mascara formula forms a flexible mascara ‘tube’ (hence the name!) that dries around each eyelash: this means it can’t smudge or flake *and* is removed with warm water at the end of the day. It’s magic! My favourite tubing mascara is Clinique Zero Gravity which you can get HERE.
👁️ Take a break from contact lenses
90% of the time I am wearing glasses because it makes my eyes less sore over time. I can comfortably wear contact lenses all day, but if I wear them a few days in a row my eyes will feel more dry and uncomfortable.
👁️Use contact lenses designed for dry eyes
There are some days you might simply need to use contact lenses, so it’s important to choose ones suitable for you. I currently use VisionDirect for my lenses, and when you have a nosey around the site they signpost the lenses that are good for comfort or hydration, so try to select those.
👁️ Avoid rubbing your eyes
I think having a good old rub at itchy eyes is one of the most satisfying feelings in the world, but it will only make your eyes more sore. Try to avoid rubbing or scratching and instead try some of the following tips…
👁️ Clean your eyelids with diluted baby shampoo
The idea of shampoo near your eyes probably made you recoil in horror, but baby shampoo is designed to be gentle for even the most sensitive skin - obviously I expect you to still be very careful and sensible!
Use reusable cotton pads or a reusable cotton swab to apply diluted baby shampoo to gently clean the eyelashes and massage the eyelids. You’re trying to break up the debris that is plugging the meibomian glands and releasing the trapped oil that helps keep your eyes hydrated. When this happens, it might make your vision a little cloudy – don’t panic, this is just the oil spreading and it soon dissipates!
Hot compresses for ocular rosacea work on the same premise as above, but the heat helps to unblock the glands a little easier. However, as rosacea is often triggered by heat, please be careful putting warm compresses near your cheeks and nose as this could trigger a flare up. It’s a careful balance of applying them on your eyes but not your cheeks!
Cold compresses won’t help unblock the meibomian glands, but they can help soothe your eyes when they feel itchy and sore. I use the circular pads included in THIS amazing gel face mask pack.
I hope you found this post useful, I’m so thankful to Mr Alex Day for his help answering your ocular rosacea questions. If you have any further questions or want clarity on anything above, just leave a comment below and I’ll try to get them answered for you.
Likes, comments, and shares of my posts indicate to Substack that this article was useful, interesting, or worth suggesting to other people, so any interaction you can give it really, really helps!
This is so informative, thank you Lex.
Hello Lex!
I've not been diagnosed yet because in France it's really difficult to find dermatologists or ophthalmologists who have an expertise on rosacea. I was lost and scared before discovering your Instagram account. So, thank you so much for sharing such useful, authentic and clear content (and thanks to specialists who participate of course). It's precious!