Researchers Define Keys to Recognizing Ocular Rosacea
Foreign body sensation and itching were about twice as prevalent in rosacea patients than in the healthy controls.
A number of eye symptoms may be more common in patients with rosacea compared to those without the skin disease, but the presence of conjunctival telangiectases may be the eye symptom most closely associated with rosacea.
Findings come from a study in which researchers evaluated the right eyes of 76 rosacea patients and 113 people with no systemic or eye disorders. The examinations included slit-lamp microscope, optical coherence tomography (OCT)-assisted meibography to analyze meibomian gland function, a standardized questionnaire about eye disease, and other assessments.
Results, published in International Ophthalmology, show that foreign body sensation and itching were about twice as prevalent in rosacea patients than in the healthy control subjects (53.9% vs. 24.8% and 35.5% vs. 17.7%, respectively), dryness was more than four times as common (46.1% vs 10.6%), and meibomian gland dysfunction was about two-thirds more common (52.6% vs. 31%). However, conjunctival telangiectasia was found to occur overwhelmingly in the rosacea patients alone (26.3% vs 1.8%).
The researchers recommend that eye doctors use detailed slit-lamp examinations to detect conjunctival telangiectasia, especially in cases of persistent dry eye symptoms. They also noted that OCT-assisted meibography may be important for identifying and evaluating meibomian gland dysfunction.
A recent study from Argentina illustrates the importance of treating ocular rosacea promptly. The eyes of 51 rosacea patients were examined by researchers, and 38 (74.5%) had signs of eye involvement. Of these, all had erythema and telangiectasia on the eyelid margin, and all but one had meibomian gland dysfunction. Fifteen patients suffered decreased visual acuity due to rosacea-related complications, including scarring and blood vessels on the cornea.
Investigators reported, “a significant association between the severity of ocular findings, assessed as a diminished visual acuity due to rosacea corneal involvement,” and the presence of rosacea symptoms of the skin, including excess tissue (rhinophyma) and bumps and pimples (papules and pustules).
The most common therapies given to the ocular rosacea patients in the study, published in Turk J Ophthalmol,were artificial tears, oral doxycycline, corticosteroid-antibiotic ointment, and a lid hygiene regimen. However, three patients required corneal transplants to restore their vision. The researchers recommended that special attention be paid to worsening eye symptoms during flare-ups of rosacea on the skin, and that patients should be referred to an ophthalmologist for treatment when vision is threatened.
“Although rosacea is generally thought of as a skin disease, research has shown that for the great majority of rosacea patients the eyes may also affected,” says Dr. Mark Mannis, chair of ophthalmology at the University of California-Davis and a member of the National Rosacea Society's medical advisory board. “In moderate to severe cases, treatment by an ophthalmologist may be especially necessary to prevent loss of visual acuity.”