Seeing red: eye symptoms of rosacea pose undetected threat

While rosacea is best known for making its victims red in the face, it can also leave them literally seeing red. Ocular rosacea, which causes redness and irritation of the eyes, may be far more common than previously recognized. It may be dramatically underdiagnosed and left untreated.

Eye symptoms quite common

In addition to having unsightly acne-like facial effects, a large percent of rosacea sufferers have eye symptoms. Eighty-nine percent of 2,010 rosacea sufferers responding to the survey indicated that they also experienced discomfort or redness of the eyes in varying degrees. However, of those with eye symptoms, only 27% reported that they had been diagnosed with ocular rosacea. Only 24% said they were treated for the condition.

"Although many people may not connect their eye symptoms with a skin disorder, this is quite common with rosacea and needs to be more widely recognized by the general public and health professionals alike," said Dr. Guy Webster. Webster is associate professor of dermatology at Thomas Jefferson University Medical College in Philadelphia. "Because of the eye symptoms, sometimes an ophthalmologist will be the first to notice rosacea and point the patient to a dermatologist."

Stinging, watery, bloodshot eyes

Visually, an eye affected by rosacea often appears simply to be watery or bloodshot. Some ocular rosacea patients experience no eye discomfort. But many feel as if there is a foreign body or something gritty in their eyes. They may also have a dry, burning or stinging sensation.

In severe cases, ocular rosacea may include:

• Swollen blood vessels (conjunctival infection)
• Inflammation of the eye or eyelid (blepharitis)
• Inflammation of the iris (iritis)
• Inflammation of the whites of the eyes (episcleritis)
• A cyst due to plugging of glands under the eyelids (chalazion)
• Loss of vision, in rare instances

A sty-an inflammation of the sebaceous glands of the eyelids-is also common in rosacea sufferers. It is believed to be potentially related to the condition.

Timing of symptoms

"One of the reasons ocular rosacea may often go undetected is the fact that these symptoms tend to develop separately from the facial symptoms of the disorder," Dr. Webster noted. Thirty-eight percent of the survey respondents said their ocular symptoms developed after their facial symptoms. Seventeen percent said their ocular symptoms occurred before facial symptoms. Only 15% reported that their eye and facial symptoms appeared at the same time.

Dr. Webster pointed out that ocular rosacea has been found in up to 58% of rosacea patients in clinical studies. It seems to worsen during the winter months. This may be a result of the frequent gusty winds and cold temperatures.

Diagnosis and treatment of ocular rosacea

The good news is that medical therapy appears to be widely effective in improving the symptoms. Of the survey respondents who had been diagnosed and treated for ocular rosacea, 90% said their condition had improved.

Once diagnosed, a physician will usually prescribe a combination of treatments for ocular rosacea tailored to the individual. This may include local and systemic therapy, as well as cleansing and tearing agents, all of which may be adjusted over time. The facial symptoms of rosacea are usually treated with oral and topical antibiotics. This is often followed by long-term therapy with the topical antibiotic alone to maintain remission.