Two New Studies Define Key Elements to Identifying Ocular Rosacea

Two New Studies Define Key Elements to Identifying Ocular Rosacea

January 26, 2022

A pair of new studies have helped establish the relative prevalence of signs and symptoms of ocular rosacea, as well as the importance of medical treatment.

“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,” said Mark Mannis, MD, 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.”

Signs and symptoms of ocular rosacea include itching, burning and stinging; inflamed eyelids and styes (blepharitis); red or bloodshot eyes (conjunctivitis); the feeling that something is in the eye (foreign body sensation); and the development of visible blood vessels (telangiectasia) on the eyelids or whites of the eyes.

The meibomian glands, which generate an oil that helps tears keep the eye moist, become clogged in some patients, causing tears to break down more quickly and resulting in dry eye. The cornea may become injured as the disease develops, resulting in decreased visual clarity.

The goal of a new study published in International Ophthalmology was to determine which ocular signs and symptoms were most related with rosacea, as well as the best diagnostic procedures.

In this study, the researchers looked at the right eyes of 76 persons with rosacea and 113 people with no systemic or eye problems.

The examinations were conducted by several methods, including slit-lamp microscope (a common device used in most eye exams), optical coherence tomography (OCT)-assisted meibography to analyze meibomian gland function, and a standardized questionnaire about eye disease.

They found 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—blood vessels on the whites of the eyes—was found to occur overwhelmingly in the rosacea patients alone (26.3% vs 1.8%).

According to the researchers, eye specialists should perform extensive slit-lamp examinations to detect conjunctival telangiectasia, especially in patients of recurrent dry eye complaints.

They also mentioned that OCT-assisted meibography could be useful for detecting and assessing meibomian gland dysfunction.

In the meantime, a recent study conducted in Argentina highlighted the need of treating ocular rosacea as soon as possible. Researchers examined the eyes of 51 rosacea patients, finding that 38 (74.5%) of them displayed symptoms of eye involvement.

Of these, all had erythema and telangiectasia on the eyelid margin, and all but one had meibomian gland dysfunction. Fifteen suffered decreased visual acuity due to rosacea-related complications, including scarring and blood vessels on the cornea.

“We found 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 investigators reported.

The most common therapies given to the ocular rosacea patients in the study were artificial tears, oral doxycycline, corticosteroid-antibiotic ointment, and a lid hygiene regimen.

Three individuals, on the other hand, needed corneal transplants to regain their vision.

The researchers recommended that during rosacea flare-ups on the skin, extra attention be paid to developing eye symptoms, and that patients should be referred to an ophthalmologist for treatment if their vision is threatened.