Ocular Rosacea

Rosacea, previously called acne rosacea, is a chronic skin disease that affects both the skin and the eyes. The disorder is characterized by redness, bumps, pimples, and, in advanced stages, thickened skin on the nose. Rosacea usually occurs on the face, although the neck and upper chest are also sometimes involved. A mild degree of eye (ocular) involvement occurs in more than 50 percent of people with rosacea.

Approximately 13 million people in the United States have rosacea. It usually occurs in adults between the ages of 30 and 60. Women are more often affected by mild to moderate rosacea than men, but the disorder is often more severe when it strikes men. Although rosacea can develop in people of any skin color, it tends to occur most frequently in people with fair skin. A tendency to develop rosacea may be inherited; often, several people in a family have it.

Symptoms

Rosacea has a variety of clinical features, or signs and symptoms. Doctors generally classify rosacea into four types based on symptoms. The earliest recognizable stage is called pre rosacea. Signs and symptoms at this stage include frequent episodes of flushing and redness of the face and neck that come and go. Many things can trigger a flare-up, including exposure to the sun, emotional stress, alcohol, spicy foods, exercise, cold wind, hot foods and beverages, and hot baths. What causes a flare-up in one person may not cause a problem in another.

Another type of rosacea, called vascular rosacea, is commonly seen in women. Blood vessels under the skin of the face swell (telangiectasia). As a result, flushing and redness become persistent and, eventually, permanent. The affected skin may be slightly swollen and warm.

Some people, often people with a history of vascular rosacea, also develop inflammatory rosacea. With this form of the disease, people develop pink bumps (papules) and pimples. Thin red lines that look like a road map may also appear as the small blood vessels of the face get larger and show through the skin.

In a few men with rosacea, a condition called rhinophyma develops. This type of rosacea is characterized by an enlarged, bulbous red nose. Both the oil-producing (sebaceous) glands and the surrounding connective tissues of the nose enlarge, and thick, knobby bumps may develop.

Some people may have more than one type of rosacea at a time. Other people can have any one type, including rhinophyma, without ever having had any of the others.

How Is the Eye Affected?

In addition to skin problems, rosacea may lead to conditions involving the eyes in about 50 percent of those affected. Typical symptoms include redness, burning, tearing, and the sensation of a foreign body or sand in the eye. Infection of the eyelids may cause the lids to become inflamed and swollen. Some patients complain of blurry vision. In severe cases a person’s vision can become impaired.

Treatment

Treatment goals are to control the condition and improve appearance. Doctors usually prescribe a topical antibiotic, such as metronidazole, that is applied directly to the affected skin.

For people with more severe cases, doctors often prescribe an oral (taken by mouth) antibiotic. Tetracycline, minocycline, erythromycin, and doxycycline are the most common antibiotics used to treat rosacea. Some people respond quickly, while others require long-term therapy.

Doctors usually treat the eye problems of rosacea with oral antibiotics, particularly tetracycline or doxycycline. People who develop infections of the eyelids must practice frequent lid hygiene. Doctors recommend scrubbing the eyelids gently with diluted baby shampoo or an over-the-counter eyelid cleaning product and applying warm (not hot) compresses several times a day.