What is Ocular Rosacea? A Complete Guide to Symptoms and Causes
If you often have red, itchy, or swollen eyes, or frequently get styes, don’t ignore these signs. They could be more than just allergies or clogged tear glands.
Sometimes, these symptoms point to a condition called ocular rosacea.
Understanding Ocular Rosacea
Ocular rosacea is a type of rosacea that affects the eyes and eyelids. Rosacea is a long-term skin condition that mainly causes redness and inflammation, often on the face.
It most often happens in women aged 30 to 50. But ocular rosacea can affect both men and women equally.
Up to 58% of people who have rosacea on their skin also have eye problems from ocular rosacea.
Interestingly, about 20% of people with ocular rosacea do not have any skin symptoms before their eye symptoms start. This means you can have ocular rosacea even if your skin looks clear and healthy.
What Are the Symptoms of Ocular Rosacea?
Ocular rosacea can cause many different symptoms, and these can affect different parts of your eyes and eyelids. You might notice one or more of these signs regularly:
Your eyes may be red, itchy, or burning.
Your eyes might feel watery or like they have something gritty inside.
You might feel your eyes are dry and uncomfortable.
Bright lights may hurt your eyes or cause discomfort.
Your eyelids could look swollen or inflamed—a condition called blepharitis.
You may see tiny red veins in your eyelids near your eyelashes.
You might get frequent eyelid infections, such as styes or chalazions (small lumps on the eyelid).
Your corneas, the clear front part of your eyes, can become inflamed. This can cause blurred vision or even vision loss if untreated.
What Causes Ocular Rosacea?
Doctors do not yet know exactly what causes ocular rosacea. However, several factors may increase your risk or contribute to the condition:
Heredity: If one or both of your parents have rosacea, you are more likely to develop it.
Bacterial infection: A common stomach bacteria called Helicobacter pylori is linked to eye inflammation in some cases.
Blocked eyelid glands: Your eyelids have tiny oil glands (called meibomian glands) that help keep your eyes moist. If these glands get clogged, it can lead to dryness and inflammation.
Eyelash mites: Everyone has tiny mites living near the eyelashes, but people with rosacea tend to have more of these mites. They may worsen inflammation.
How is Ocular Rosacea Diagnosed?
There is no single test that can diagnose ocular rosacea. Instead, doctors look at your medical history and carefully examine your eyes.
To be diagnosed with ocular rosacea, you usually must show at least two symptoms, and often skin symptoms of rosacea as well. But remember, some people have ocular rosacea without skin signs.
Ocular rosacea is classified into three stages:
Grade 1 (Mild): Mild itching, burning, or a gritty feeling in the eyes.
Grade 2 (Moderate): More intense burning, stinging, or crustiness around the eyes and lids.
Grade 3 (Severe): Pain, sensitivity to light, or blurry vision.
How is Ocular Rosacea Treated?
While there is no cure for ocular rosacea, treatments can reduce symptoms and prevent damage to your eyes. Early treatment is important because untreated ocular rosacea can lead to permanent vision problems.
Your treatment plan depends on how severe your symptoms are. Usually, the first step is to improve eyelid hygiene:
Wash your eyelids gently twice a day with warm water or diluted baby shampoo.
Use artificial tears (eye drops) to relieve dryness.
Avoid eye makeup during flare-ups. If you must wear makeup, choose fragrance-free and non-oily products.
Do not wear contact lenses when your eyes are inflamed or dry.
Avoid triggers that worsen rosacea, like spicy foods or alcohol.
If symptoms are worse, your doctor may prescribe antibiotics. These can be taken by mouth or applied as eye drops. Common antibiotics include doxycycline, tetracycline, minocycline, azithromycin, and erythromycin.
Antibiotics help reduce infection and calm inflammation. Usually, doctors prescribe lower doses for longer times to control symptoms safely.
Sometimes, if inflammation is severe or other treatments don’t work, doctors may recommend steroid eye drops. These help reduce swelling but should only be used for a short time.
Long-term use of steroids can cause eye problems like glaucoma or cataracts.
A safer alternative for long-term inflammation control is topical cyclosporine. This medicine suppresses the immune system locally and helps especially with dry eyes.
Some studies suggest that taking Omega-3 fatty acids (found in fish oil supplements) may ease dry eye symptoms and inflammation.
If you have stubborn lumps on your eyelids, like chalazions or styes, surgery might be needed to remove them.
What Triggers Ocular Rosacea Flare-Ups?
Ocular rosacea often worsens with the same triggers that affect skin rosacea. If you have both conditions, you might notice flare-ups in your eyes and skin together. Common triggers include:
Eating spicy foods.
Drinking alcohol.
Exposure to sunlight, wind, or very hot or cold weather.
Strong emotions such as stress, anger, or embarrassment.
Intense exercise.
Hot baths or saunas.
Avoiding your personal triggers can help keep symptoms under control.
When Should You See a Doctor?
If your eyes are red, itchy, or burning regularly, see your primary care doctor. They can examine you and refer you to an eye specialist, like an optometrist or ophthalmologist, if needed.
You should also visit an eye doctor if your symptoms get worse or if flare-ups happen more often. Be sure to tell them about any new symptoms or things that trigger your condition.
Go to the emergency room if you experience any of the following:
Severe eye pain.
Dizziness.
Loss of vision.
Blurry or double vision.
These can be signs of serious eye problems that need immediate treatment.
Living with Ocular Rosacea
Although ocular rosacea cannot be cured, proper treatment and good eye care can keep symptoms manageable. By working closely with your doctor, you can create a plan to control the condition and protect your vision.
Regular eyelid hygiene, avoiding triggers, and following treatment recommendations help prevent flare-ups and reduce discomfort.
