Ocular Rosacea: What It is, Symptoms, Causes and Treatments

• Ocular rosacea is a chronic inflammatory condition of the eyes that causes symptoms such as discomfort, redness and stinging.
• Ocular rosacea often presents alongside facial rosacea.
• Oral antibiotics, eye drops and eyelid wash are most frequently recommended to treat symptoms.
• Ocular rosacea is a condition that may be effectively managed through your doctor’s treatment plan and diligent home care.
• Untreated ocular rosacea can result in corneal damage or ulceration, leading to blindness.

Ocular rosacea is a chronic, inflammatory condition that causes redness, burning, stinging, and inflammation of the eyes and eyelids. This condition tends to affect people with facial rosacea.

While symptoms will come and go, there is no cure for ocular rosacea. Oral medications and eye drops are used to manage the symptoms.

What Is Ocular Rosacea?

Ocular rosacea causes redness, inflammation and discomfort in and around the eyes. It is closely linked with facial rosacea; sometimes the two conditions overlap and other times ocular rosacea presents on its own.

Scientific studies reveal that 58–72% of rosacea patients also have ocular rosacea, and approximately 10 million patients in the United States alone have been diagnosed with the condition. 

Ocular rosacea causes a range of eye discomforts and can lead to corneal damage and vision loss if left untreated. 

Symptoms of Ocular Rosacea

Some ocular rosacea symptoms overlap with other conditions such as seasonal allergies and eye strain, making it difficult to diagnose. Symptoms may be mild to severe; some individuals may experience multiple signs or only a few of the following:

• Itchy, red eyes
• Burning or stinging 
• Dry eyes
• Watery eyes
• The sensation of sand, grit or other foreign bodies in the eye
• Swelling (edema) of the eyelids
• Blurry vision
• Red or bloodshot eyes
• Pink eye (conjunctivitis)
• Tiny, dilated blood vessels in the whites of the eyes
• Light sensitivity
• Formation of styes
• Damage to the cornea
• Corneal neovascularization (blood vessel growth on the cornea)
• Corneal ulcer

If your dermatologist or optometrist suspects ocular rosacea, you’ll likely be referred to an ophthalmologist for further treatment recommendations.

Ocular rosacea is closely related to facial rosacea. It can manifest before or after facial rosacea symptoms appear, and it can be difficult to diagnose.  

Causes of Ocular Rosacea

As with facial rosacea, the exact causes of ocular rosacea have yet to be determined.  However, there are certain factors that are linked to rosacea, including:

• Heredity
• Abnormalities of the blood vessels in the face
• Protein-like structures called cathelicidins, which are related to immune system abnormalities
• Demodex dust mites, which are found in high numbers on the skin and in the eyelashes of people with rosacea

In one study, 85% of the patients surveyed had a condition called meibomian gland dysfunction. This is a gland in the eyelid that normally secretes a fatty lubricant which keeps the eyes from drying out. With this condition, the glands do not function properly. Symptoms of this dysfunction include dry eye, chalazions (benign cysts) and styes.

Another commonality among ocular rosacea patients appears to be in the glycans that are naturally present in tears. Researchers have identified differences in the glycans of rosacea patients versus those in people without rosacea.

Triggers

The same triggers that cause a rosacea flare can also contribute to worsened ocular rosacea symptoms. Some of these triggers include certain foods and beverages, such as spicy foods, hot drinks, alcohol, fermented foods, processed foods and foods that release histamines in the body. 

Other triggers include overexposure to the sun, emotional stress, weather extremes, certain skin care products, strenuous exercise, hot baths and some medications.

Ocular rosacea treatments

People diagnosed with ocular rosacea must follow a strict eye care regimen to soothe discomfort and prevent potential vision loss.

You will likely be able to control ocular rosacea through medications and diligent eye care at home. It’s also possible that ocular rosacea symptoms will subside temporarily on their own.

Eye drops

Your ophthalmologist may prescribe prescription steroid eye drops to soothe any inflammation in your eyes or eyelids. Eye drops can also lubricate the eyes and help prevent corneal damage.

If you purchase over-the-counter (OTC) eye drops for ocular rosacea, sterile saline solution is optimal. Drops that address red, bloodshot eyes may actually worsen your ocular rosacea symptoms.

Oral antibiotics

Oral antibiotic therapy is commonly prescribed to treat ocular rosacea. Your doctor may prescribe a short cycle (about six weeks) of doxycycline, minocycline, erythromycin or tetracycline to address your symptoms. Best results are seen after three months of medication, however if symptoms are severe, you may need a long-term, low-dose antibiotic.

Eyelid wash

Using a prescription eyelid wash for blepharitis (eyelid inflammation) may help soothe some of the discomfort associated with ocular rosacea. Additionally, some doctors recommend using no-tears baby shampoo.

Meibomian gland surgery

A surgical procedure to open blocked meibomian glands can help alleviate symptoms of ocular rosacea. The procedure allows the glands to function properly and keep the eyes lubricated.

Natural treatments for ocular rosacea

By making some adjustments to your lifestyle, you can minimize your symptoms and help reduce the risk of rosacea flares. 

• Avoid foods, beverages, ingredients or activities that may trigger a symptom flare 
• Follow a rosacea diet to identify food triggers and reduce flare-ups
• Avoid wearing makeup if you’re experiencing eye inflammation.
• Use makeup and facial products that are fragrance-free and noncomedogenic.
• Don’t wear contact lenses when you’re experiencing a symptom flare.

For best results, combine lifestyle changes with your doctor’s treatment plan.

Does the rosacea diet work?

Some research indicates that patients often cite food and beverage triggers as a cause for their rosacea flares. According to one survey, 95% of rosacea patients who responded said that following dietary changes had reduced their symptom flares.

While eliminating certain trigger foods from your diet may help reduce your risk of flare-ups, there is no guarantee that any specific diet will minimize or cure your ocular rosacea. However, many people follow specific diets to help them control their rosacea symptoms, and there is some evidence that eliminating certain foods can help some people with their symptoms. 

Eating an alkaline diet is also widely recommended as a potential rosacea cure, but that diet is intended to bring the body from an acidic state into a more balanced pH. However, pH hasn’t been identified as a possible cause of rosacea; eating alkaline foods likely won’t affect your symptoms of ocular or facial rosacea.

Risks and Complications

Untreated ocular rosacea can lead to corneal damage and ulceration; blindness can result. 

Ocular rosacea blepharitis

Blepharitis is an inflammation of the eyelids that is sometimes associated with ocular rosacea. Demodex mites in the eyelashes are one cause of blepharitis, and those who have rosacea have been found to have a higher occurrence of Demodex blepharitis. Some blepharitis symptoms overlap with the symptoms of ocular rosacea. 

If you have been diagnosed with blepharitis alongside ocular rosacea, it’s crucial to wash your eyelids regularly and apply any treatments your ophthalmologist recommends.

When to see a doctor

If you’re experiencing ongoing discomfort in your eyes, blurry vision, watering, redness or pain, it’s important to see your doctor and begin a treatment plan. If you’ve already been diagnosed with rosacea, and symptoms do not improve or worsen, see your ophthalmologist to discuss adjusting your treatment. 

Takeaway

Ocular rosacea causes eye discomfort and irritation and is a chronic condition with no cure.  The condition affects people both with and without facial rosacea. 

If left untreated, ocular rosacea can damage the cornea and lead to vision loss, although people with minor cases may only experience mild discomfort. 

Diligent home treatment and medications can help reduce your symptoms. It’s also critical to have your eyes checked regularly for potential corneal damage. Your doctor will need to assess how effective your current treatment plan is, and make any adjustments necessary.