What is ocular rosacea, or rosacea type 4?

I wrote a really popular blog post on ocular rosacea about 5 years ago, but I realised my website needed an updated version with tips I’ve learned since and more information. Whether you’re newly diagnosed with ocular rosacea or are a long-time sufferer, hopefully this post will offer some help.

WHAT IS OCULAR ROSACEA?

Ocular rosacea is an inflammatory condition that affects the eyes. It’s similar in appearance and feeling to other eye irritations which is why it’s often not linked to the accompanying rosacea subtypes. It is often referred to as rosacea subtype 4 (although subtype classifications are falling out of favour, as I covered in THIS POST).

WHAT ARE OCULAR ROSACEA SYMPTOMS?

The main symptoms of ocular rosacea are: dry-feeling eyes, irritation or burning, watery or bloodshot appearance (telangiectasia), blepharitis (swollen and inflamed eyelids), styes, sensitivity to light, crusting around the lashes, loss of eyelashes/misdirected eyelashes, and a gritty sensation as though there’s a foreign object in the eye.

HOW COMMON IS OCULAR ROSACEA?

According to the National Rosacea Society, ocular rosacea is believed to affect 60% of people with rosacea, so roughly 6% of the general population! It typically occurs in patients with existing rosacea (particularly type 1/erythematotelangiectatic/vascular rosacea), but it can be the first sign of the condition. However, most people aren’t aware that their sensitive eyes are a symptom of rosacea so it can often go untreated. It is believed to affect men and women equally, is most likely to start after age 30, and is most common in people over the age of 50.

WHAT CAUSES OCULAR ROSACEA?

A fascinating study of ocular rosacea patients discovered that “85 percent had meibomian gland dysfunction. The meibomian glands line the edge of the eyelid and secrete a fatty substance that helps keep the eye from drying out. Plugging of these glands may result in dry eye, styes or chalazions (a type of benign cyst).” For this reason, ocular rosacea is sometimes referred to as Meibomian Gland Dysfunction (MGD). You can read all about the study HERE, including information on how ocular rosacea can worsen and affect overall eye health and eyesight.

There are also theories about the differences in glycans (a type of molecule in tears and saliva) between rosacea patients and healthy patients, and further theories related to demodex mites and the associated bacteria affecting the eyes.

HOW TO TREAT OCULAR ROSACEA?

Your first step is to speak to either your dermatologist or your ophthalmologist to get confirmation that it is definitely ocular rosacea. Once you get confirmation, they will hopefully be able to advise whether you can self-manage your symptoms using the tips below, or whether you need medical support.

HOW TO SOOTHE OCULAR ROSACEA?

Here are some tips to manage your ocular rosacea symptoms, but please use common sense with these: your eyes are incredibly delicate and sensitive even without ocular rosacea!

• Try to include Omega-3 in your diet
  • Omega-3 is thought to help with dry eye symptoms so including it in your diet every week is a really great idea. Luckily I love oily fish so it’s not a chore for me to eat it, but if you can’t get Omega-3 into your diet through diet, have a look at supplements like these from Seven Seas.
• Give your eyes regular breaks
  • I work on screens all day and really notice that my eyes are more sore if I don’t give myself breaks. Try to have complete breaks from screens for at least 5 minutes every hour (that means laptops *and* phones, tablets etc). I was also told by my ophthalmologist that I don’t blink properly (I know, I didn’t believe it either!) when I’m concentrating so the bottom half of my eyes are more dry than the top half. So when I give myself screen breaks, I try to have a good blinking session (a phrase I never thought I would have to type but here we are…)
• Protect your eyes from extreme weather
  • UV-protected sunglasses (on sunny and/or windy days) and wide-brimmed hats/caps will really help with streaming and sore eyes.
• Use eye drops
  • I have eye drops in my handbag so that I can calm that horrible itching feeling as soon as it starts. I say ‘eye drops’, but it’s actually THIS amazing spray which is so much easier to use.
• Use skincare designed for sensitive eyes
  • As people with rosacea, it’s unlikely we’re using skincare products with fragrance or high levels of actives but just in case, these are not suitable for your delicate eye area. You can read about my current skincare routine HERE. I don’t necessarily believe that you NEED a separate eye cream if you feel like your moisturiser is light enough to go all over your eyes, however if you are looking for a separate product I really like the cooling gel feel of THIS one from Clinique.
• Use make-up designed for sensitive eyes
  • I’m going to do a blog post on the specifics of this, but my main tip is to find eye make up that firstly doesn’t irritate your sensitive eyes, but secondly doesn’t budge when your eyes are streaming. Tubing mascara is really clever as the mascara formula forms a flexible mascara ‘tube’ (hence the name!) around each eyelash: this means it can’t smudge or flake *and* is removed with warm water at the end of the day. It’s magic! My favourite tubing mascara is Clinique Zero Gravity.
• Have a break from contact lenses
  • 90% of the time I am wearing glasses because it makes my eyes less sore over time. I can comfortably wear contact lenses all day, but if I wear them a few days in a row my eyes will feel more dry and uncomfortable.
• Use contact lenses aimed at dry eyes
  • There are some days you might simply need to use contact lenses, so it’s important to choose ones suitable for you. I currently use VisionDirect for my lenses, and when you have a nosey around the site they signpost the lenses that are good for comfort or hydration, so try to select those.
• Avoid rubbing your eyes
  • I think having a good old rub at itchy eyes is one of the most satisfying feelings in the world, but it will only make your eyes more sore. Try to avoid rubbing or scratching and instead try some of the following tips…
• Clean your eyes with diluted baby shampoo
  • The idea of shampoo near your eyes probably made you recoil in horror, but baby shampoo is designed to be gentle for even the most sensitive and delicate skin. Use reusable cotton pads or a reusable cotton swab to apply diluted baby shampoo to gently clean the eyelashes and massage the eyelids. You’re trying to break up the debris that is plugging the meibomian glands and releasing the trapped oil that helps keep your eyes hydrated. When this happens, it might make your vision a little cloudy – don’t panic, this is just the oil spreading and it soon dissipates!
• Apply hot compresses (with care!)
  • Hot compresses for ocular rosacea work on the same premise as above, but the heat helps to unblock the glands a little easier. However, as rosacea is often triggered by heat, please be careful putting warm compresses near your cheeks and nose as this could trigger a flare up.

I really hope you found this post useful. It took a long time to pull together (and 18 years of experience helped me to write it!) so please help this blog continue to provide free-to-read content. Access to my content (and everything I’ve shared over the past 10 years) is free, but to continue to see more posts like this (both for the benefit of you and the benefit of others), please support the site through my Ko-Fi link.

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