Rosacea

Rosacea and the Eyes (Ocular Rosacea)

Rosacea is a chronic inflammatory skin condition that most commonly affects the face, but for many people, it also affects the eyes and eyelids. This form is known as ocular rosacea and is a frequently overlooked cause of persistent dry eye symptoms, blepharitis, and recurrent styes or chalazions.

Because ocular rosacea often goes undiagnosed, patients may struggle with eye discomfort for years before receiving appropriate treatment.

What Causes Rosacea?

The exact cause of rosacea is not fully understood, but it is believed to involve a combination of:

• Chronic inflammation
• Abnormal blood vessel regulation
• Overactive immune response
• Bacterial imbalance on the skin
• Genetic predisposition

Rosacea tends to flare in response to specific triggers, which can vary from person to person.

Common Rosacea Triggers

Triggers may include:

• Heat or sun exposure
• Hot beverages or spicy foods
• Alcohol (especially red wine)
• Stress or emotional changes
• Exercise
• Cold or windy environments
• Certain skincare products

When rosacea flares, inflammation can extend to the eyelids and oil glands, directly impacting tear film stability.

What Is Ocular Rosacea?

Ocular rosacea occurs when rosacea-related inflammation affects the eyelids, meibomian glands, and ocular surface.

Common signs and symptoms include:

• Dry, burning, or gritty eyes
• Red or bloodshot eyes
• Chronically red or inflamed eyelid margins
• Frequent styes or chalazions
• Light sensitivity
• Blurred vision that improves with blinking
• Excessive tearing despite dryness

Many patients with ocular rosacea may have minimal or no facial symptoms, making diagnosis more challenging.

How Rosacea Affects Dry Eye

Rosacea-related inflammation disrupts the meibomian oil glands, leading to:

• Thickened or poor-quality oils
• Blocked glands
• Increased tear evaporation
• Chronic eyelid inflammation

This creates a cycle in which inflammation worsens dryness, and dryness further fuels inflammation.

Diagnosis

Ocular rosacea is diagnosed based on:

• Eyelid and ocular surface examination
• Meibomian gland evaluation
• Symptom history and flare patterns
• Presence (or history) of facial rosacea

Early diagnosis allows for more effective symptom control and prevents long-term gland damage.

Treatment Options

Ocular rosacea requires a multifaceted, long-term treatment approach focused on inflammation control and gland health.

At-Home Management

• Daily lid hygiene with gentle cleansers
• Warm compresses to improve oil flow
• Trigger identification and avoidance
• UV protection (sunglasses, hats)

Dry Eye Treatments

Advanced therapies may include:

Intense Pulsed Light (IPL)

Reduces abnormal blood vessels, inflammation, and bacterial load; improves meibomian gland function.

Meibomian Gland Expression treatments

Helps clear blocked glands and restore oil flow.

Blephex Treatment

Removes inflammatory debris and bacterial biofilm.

Prescription medications

Anti-inflammatory or antibiotic therapies (topical or oral) may be used to control flare-ups.

Why Ocular Rosacea Is Chronic

Rosacea is a lifelong condition with periods of remission and flare-ups. While it cannot be cured, symptoms can be effectively managed with consistent care and early intervention.

Without treatment, chronic inflammation can lead to:

• Progressive meibomian gland damage
• Worsening dry eye disease
• Recurrent eyelid infections

Preventing Flare-Ups and Long-Term Control

Successful management focuses on:

• Identifying and minimizing personal triggers
• Maintaining consistent eyelid hygiene
• Treating underlying dry eye disease
• Scheduling regular follow-up evaluations

A proactive approach can significantly improve comfort and quality of life.

When to Seek Care

You should seek professional evaluation if:

• Dry eye symptoms persist
• Eyelid redness or irritation worsens
• Styes or chalazions recur frequently
• Vision becomes affected

Early diagnosis and targeted therapy can prevent long-term complications.