Ocular Rosacea

Ocular Rosacea

Eye & Vision
Skin Care
Contributed byLester Fahrner, MD+1 moreJun 07, 2021

What are the other Names for this Condition? (Also known as/Synonyms)

  • Ophthalmic Rosacea
  • Rabbit Eyes
  • Subtype 4 Rosacea

What is Ocular Rosacea? (Definition/Background Information)

  • Rosacea is a common skin condition visible as reddish skin with papules and pustules on the face. It is more frequently observed in young and middle-aged women. It can be also seen in males and be present from childhood through life. It occurs due to inflammation of the sweat glands and hair follicles
  • Ocular Rosacea is a subtype of rosacea that affects the eyes and eyelids. It has been reported that over 50% of the individuals with rosacea have Ocular Rosacea
  • Some risk factors for developing Ocular Rosacea include having had acne as an adolescent, indulging in alcohol drinking, being fair skinned, and being a woman
  • The exact cause of Ocular Rosacea is not known. However, there is some evidence to show an association of “small intestinal bacterial organisms or SIBO” with the condition. It must be noted that Ocular Rosacea is not an infectious or communicable disease
  • Some reported symptoms of Ocular Rosacea are redness, eye irritation, a sensation of foreign body in the eye, blurring of vision, and inflammation. A healthcare provider or specialist may perform an eye examination, dermoscopy, skin biopsy, microscopic examination of plucked eyelashes, or examination of conjunctival scrapings to diagnose Ocular Rosacea
  • Since the precise cause of the condition is not known, there are no treatment measures available to cure Ocular Rosacea. Cold compresses, ointments, and antibiotics may be recommended as warranted. Additionally, patients are usually advised to minimize aggravating the condition
  • In some individuals, the symptoms may disappear over time. In others, the condition might become chronic with periods of intensified symptoms and remissions. Ocular Rosacea could lead to complications, such as corneal scarring, infections of the sinuses, and in rare cases, vision loss
  • The prognosis for Ocular Rosacea is considered to be good with suitable treatment and avoiding factors that exacerbate the condition; nevertheless, Ocular Rosacea can recur

Who gets Ocular Rosacea? (Age and Sex Distribution)

  • Although Ocular Rosacea may affect individuals of any age, it generally affects adults between 25-70 years of age 
  • Ocular Rosacea can affect both genders, although the condition is more common in women
  • The condition is more common in fair-skinned individuals when compared to dark-skinned individuals
  • Ocular Rosacea could affect people of all geographic regions, races and ethnicities. Although, individuals in Northern Europe are reported to be more prone to the condition

What are the Risk Factors for Ocular Rosacea? (Predisposing Factors)

Some risk factors associated with Ocular Rosacea include:

  • Having had acne during adolescence
  • Being fair-skinned: Generally, Europeans and Americans have a higher risk

Additionally, if an individual already has Ocular Rosacea, then the following may aggravate the condition:

  • Increased alcohol consumption
  • Sun exposure
  • Exposure to heat such as while working in the kitchen or a factory
  • Eating spicy food
  • Anxiety and stress
  • Drinking hot fluids/beverages: Since Ocular Rosacea is often associated with cutaneous rosacea,  drinking hot fluids can worsen that component of the condition (such as around the mouth or central facial skin)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ocular Rosacea? (Etiology)

  • The precise cause for the development of Ocular Rosacea is unknown
  • There is some evidence to show an association with small intestinal bacterial organisms (SIBO) and Ocular Rosacea
  • However, it must be noted that Ocular Rosacea is not an infectious condition, and it is not contagious

What are the Signs and Symptoms of Ocular Rosacea?

Ocular Rosacea affects the eye causing symptoms that resemble conjunctivitis. These include:

  • Continuous discharge of water from the eyes
  • Itching and redness of the eye
  • Eye pain and inflammation
  • Swelling of the eyelid (blepharophyma)
  • Sensitivity to light
  • Feeling of sand or foreign particles in the eye
  • Blurred vision
  • Corneal ulceration
  • Rosacea keratitis

How is Ocular Rosacea Diagnosed?

There is no particular test available to definitively diagnose Ocular Rosacea. A diagnosis may involve the following tests and procedures:

  • A physical examination; eye examination by an ophthalmologist
  • Dermoscopy, which involves examining the skin using a special magnified lens
  • Slit lamp exam (if necessary), for a detailed study of the eye
  • Blood analysis; to measure serum IgE level, eosinophil count
  • Allergy skin test or radioallergosorbent test; to determine the specific allergy-causing substance
  • Examination of conjunctival scrapings; culture to rule out infectious cause

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ocular Rosacea?

Ocular Rosacea is a chronic skin condition. It could result in the following potential complications:

  • Rosacea can move to affect other parts of the face/body with time
  • Secondary bacterial or fungal infections due to ulceration and bleeding of the lesions occurring elsewhere on the face
  • Sinusitis
  • Corneal damage and corneal scar
  • Damage to the eye, loss of vision (which occurs only in rare cases)
  • Aggravation of the condition by factors such as drinking alcohol, caffeine containing drinks, anxiety, certain foods, over-exercising, etc.
  • Recurrence of the condition

How is Ocular Rosacea Treated?

Since the exact cause of Ocular Rosacea is not known, there is no single cure for the condition. Treatment options are determined by the type and severity of symptoms and geared toward reducing the severity of symptoms. The treatment may involve the following measures:

  • Application of cold compress can help reduce discomfort
  • Topical creams and antibiotics
  • Oral medications such as antibiotics
  • Protection from sun, such as through sunscreen lotions and protective clothing (use of full-sleeved shirts, wide-brimmed hats, etc.)
  • Controlling factors that might worsen the condition, such as exposure to dust and smoke, or other eye irritants
  • Follow-up care with regular screening and checkups

Note: Topical applications and oral medications containing steroids are known to make the condition worse.

How can Ocular Rosacea be Prevented?

Currently, there are no reported methods of preventing Ocular Rosacea. However, avoiding the following factors may help prevent it from getting worse:

  • Alcohol consumption (is the most important aggravating factor)
  • Caffeinated drinks
  • Stress and anxiety
  • Vigorous exercise
  • Use of topical or oral steroids, including nasal steroid sprays
  • Foods containing high levels of histamines such as pickled foods, canned foods, certain cheese varieties, smoked meat, shellfish, beans and pulses, including certain nuts (cashew, almonds)
  • Spicy foods and hot liquids
  • Prolonged and chronic exposure to the sun
  • Excessive sunbathing, use of tanning beds, sun lamps, and chemical agents, that accelerate sun tanning
  • Exposure to excess heat, at home or in an industrial setting
  • Environments containing dust and smoke

Note: Keeping a journal to record what triggers the condition may help in preventing Ocular Rosacea from becoming severe.

What is the Prognosis of Ocular Rosacea? (Outcomes/Resolutions)

The prognosis of Ocular Rosacea is considered to be good with appropriate treatment.

  • It also depends upon the severity of the signs and symptoms and spread of rosacea to other parts of the face; visual disturbances can complicate the condition and make the prognosis worse
  • The condition can recur even after complete resolution following treatment. Many researchers believe that Ocular Rosacea is a lifelong condition
  • In some cases, the signs and symptoms may disappear even without treatment

Additional and Relevant Useful Information for Ocular Rosacea:

There are 4 subtypes of Rosacea based on the pattern of common symptoms. These include:

  • Erythematotelangiectatic Rosacea
  • Papulopustular Rosacea
  • Phymatous Rosacea
  • Ocular Rosacea
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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team


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