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Subtype 4:

Ocular rosacea is common but often not recognized by the clinician.[1] It may precede, follow, or occur simultaneously with the skin changes typical of rosacea. In the absence of accompanying skin changes, ocular rosacea can be difficult to diagnose, and there is no test that will confirm the diagnosis. Patients usually have mild, nonspecific symptoms, such as burning or stinging of the eyes. A sensation of dryness is common, and tear secretion is frequently decreased. [2] Mild-to-moderate ocular rosacea (including blepharoconjunctivitis, chalazia, and hordeola) occurs frequently, whereas serious disease with the potential for visual loss, such as that which results from keratitis, occurs rarely. 

"Probably the first description of ocular rosacea was by the famous English dermatologist Willan in the earl 1800’s whose handwritten note on an illustration fo a patient with PPR documented the presence of ocular inflammation." [16] 

Ocular problems occur in at least 50 percent of patients with rosacea. [3]

"Although considered a skin disease, rosacea may evolve the eyes in 58-72% of the patients, causing eyelid and ocular surface inflammation. About one third of the patients develop potentially sight-threatening corneal involvement. Untreated rosacea may cause varying degrees of ocular morbidity." [14]

There may be a clinical diagnositic test now available for ocular rosacea. [4]

One report said, "Patients with rosacea have thinner corneas, which could be attributed to the observed deteriorated tear function parameters." [12]

For images of Ocular Rosacea click here:



Treating ocular rosacea (from the AAO)

Topical Cyclosporine Proves Beneficial For Ocular Rosacea [6]

Avermectin Milbemycin Eyewash for Ocular Rosacea [7]

Might consider demodex mite treatment. [8]

Terpinen-4-ol (T4O) Pass [11]

One report states, "We suggest that a clinically acceptable dosage of PRP provides the ocular surface with the components necessary to restore normal cellular tensegrity and provides a foundation to eliminate the recurrence of the inflammation associated with DES [Dry eye syndrome]." [13]

Cliradex [15]

Diagnostic Test

While there is no diagnostic test for Ocular Rosacea there may be indicators coming down the pipeline for such a test. One paper suggests, "The abundance of highly fucosylated N-glycans in the control samples and sulfated O-glycans in ocular rosacea patient samples may lead to the discovery of an objective diagnostic marker for the disease." [9] Another paper suggests, "The high abundance of oligosaccharides in the tear fluid of patients with rosacea may lead to an objective diagnostic marker for the disease." [10]

"There is not yet a diagnostic test for rosacea. The diagnosis of ocular rosacea relies on observation of clinical features, which can be challenging in up to 90% of patients in whom accompanying roseatic skin changes may be subtle or inexistent." [14]

Links [5]

Dry Eye: Awareness, Diagnosis, and Management

All of the ocular rosacea articles at rosacea news

Ocular Rosacea: Dr. Eric Jones, MD

Ocular Rosacea: Dr. Mark J. Mannis, MD

Ocular Rosacea: Curse of the Celts and Celebs, Heather Potter, MD, University of Wisconsin, School of Medicine and Public Health

End notes

[1] Kligman AM. Ocular rosacea: current concepts and therapy. Arch Dermatol 1997;133:89-90.[CrossRef][iSI] [Medline]

[2] Gudmundsen KJ, O'Donnell BF, Powell FC. Schirmer testing for dry eyes in patients with rosacea. J Am Acad Dermatol 1992;26:211-214.[iSI] [Medline]

[3] Rosacea: A Common, Yet Commonly Overlooked, Condition
Am Fam Physician. 2002 Aug 1;66(3):435-441.

[4] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea
Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan, Hao Liu,‡ Carlito B. Lebrilla, Lenio S. Alvarenga, and Mark J. Mannis
J. Proteome Res., 2005, 4 (6), pp 1981–1987, October 6, 2005, American Chemical Society

Trail of Tears May Lead to the First Diagnostic Test for Ocular Rosacea
Ocular Rosacea Test
Updated: 6/21/2006 9:16:46 AM Dental Care & Health Care Articles

[5] Link list courtesy of David Pascoe

[6] Topical Cyclosporine Proves Beneficial For Ocular Rosacea
Skin and Allergy News, Medical Dermatology
BRUCE JANCIN, Skin & Allergy News Digital Network

[7] Patent applied for by Galderma
David Pascoe's comment on the above patent

[8] In vitro and in vivo killing of ocular Demodex by tea tree oil.
Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC.
Ocular Surface Center, 7000 SW 97 Avenue, Suite 213, Miami, FL 33173, USA.
Br J Ophthalmol. 2005 Nov;89(11):1468-73.

[9] Glycomic analysis of tear and saliva in ocular rosacea patients: the search for a biomarker.
Vieira AC, An HJ, Ozcan S, Kim JH, Lebrilla CB, Mannis MJ.
Ocul Surf. 2012 Jul;10(3):184-92. Epub 2012 May 3.

[10] Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea
Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan,Hao Liu, Carlito B. Lebrilla, Lenio S. Alvarenga,and Mark J. Mannis
J. Proteome Res., 2005, 4 (6), pp 1981–1987, DOI: 10.1021/pr0501620, Publication Date (Web): October 6, 2005

[11] In clinical trials as of August 2012:
Demodex Blepharitis Treatment Study (DBTS)

[12] Can J Ophthalmol. 2012 Dec;47(6):504-8. doi: 10.1016/j.jcjo.2012.07.009.
Central corneal thickness in patients with mild to moderate rosacea.
Onaran Z, Karabulut AA, Usta G, Ornek K.

[13] Optometry. 2012 Mar 30;83(3):111-3.
Dry-eye--is inflammation just the tip of the iceberg?
Jarka ES, Kahrhoff M, Crane JB.

[14] Arq Bras Oftalmol. 2012 Oct;75(5):363-9.

Ocular rosacea: a review.

Vieira AC, Höfling-Lima AL, Mannis MJ.
[16] Rosacea: Diagnosis and Management, By Frank Powell
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