The optimum standard treatment for ocular rosacea is the use of Rosacea-Ltd IV which is the most effective process for solving ocular rosacea. Ocular rosacea patients are very impressed with the improvements to the eye with the use of Rosacea-Ltd IV as facial rosacea patents are happy with the improvement to their skin. Rosacea-Ltd IV is the 4th generation since the world wide distributioin began in 1997.

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.

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.

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 about 20% 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 is 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 (eg, tetracycline, doxycycline, minocycline) are the mainstay. These drugs act by 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 atopical steroids for an acute situation of ocular rosacea for 10-14 days.

"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.

Page 1 2

Click below to access another page within the INTERNATIONAL ROSACEA FOUNDATION site.

[Symptoms of Rosacea] [Ocular Rosacea] [Acne Factor] [Dermatitis Factor] [Lifestyle Recommendations] [Oral & Topical Antibiotics] [Non-Prescription Treatments] [Prescription Treatments] [Topical Steroids] [Chemical Peels & Retinoids] [Laser Treatments] [Glossary] [Summary] [Citations] [International Rosacea Foundation Home] [Clinical Trials Resource Center]