{"id":62490,"date":"2024-03-27T13:05:04","date_gmt":"2024-03-27T17:05:04","guid":{"rendered":"https:\/\/womeninoptometry.com\/?p=62490"},"modified":"2024-03-27T17:47:12","modified_gmt":"2024-03-27T21:47:12","slug":"rosacea-and-ocular-health","status":"publish","type":"post","link":"https:\/\/staging.womeninoptometry.com\/views\/article\/rosacea-and-ocular-health\/","title":{"rendered":"Rosacea and Ocular Health"},"content":{"rendered":"
By\u00a0Selina McGee, OD, FAAO, Dipl. ABO<\/span><\/strong><\/p>\n This story was originally published in Review of Presbyopia and the Aging Eye<\/a>.<\/em><\/p>\n<\/div>\n Rosacea is a common skin condition that can affect the patients we encounter every day during a comprehensive eye exam. As more optometrists recognize and treat this chronic condition, it\u2019s important to consider identification, subtypes, and ongoing management. More than half of patients identified with rosacea will have symptoms that relate to their ocular health. Patients can have dryness, photophobia, foreign-body sensation and co-morbidities such as blepharitis and keratitis that ultimately can compromise vision.1<\/sup><\/p>\n Rosacea is a common, chronic skin condition of which the pathophysiology and pathogenesis are poorly understood. In 2017, an updated system of classifying rosacea through phenotype has been supported worldwide and by the National Rosacea Society. It includes any two of the following: non-transient erythema, flushing, telangiectasias, edema, papules and pustules. These all make up the fixed central facial erythema phenotype.2<\/sup><\/p>\n The second phenotype is phymatous changes, which are typically seen on the nose and are more common in men.2<\/sup> Itching, burning and stinging are secondary characteristics that can also occur with rosacea.2\u00a0<\/sup>See Figures 1 and 2 for classic examples of patients suffering with facial and ocular rosacea.<\/p>\n Demodex:\u00a0<\/strong>While there is no study demonstrating causation of demodex and rosacea, there is a strong correlation with rosacea and demodex mites.3<\/sup>\u00a0Rosacea is a significant risk factor for demodex blepharitis and vice versa. One study found that demodex blepharitis had a higher prevalence in the papulopustular variety than those with erythematous telangiestasia.4<\/sup>\u00a0This supports what we know about\u00a0Demodex folliculorum\u00a0<\/em>and that the mite enjoys snacking on sebum. When you see demodex blepharitis be on the lookout for rosacea, and when you see rosacea of the face, look carefully and examine eyelid margins closely for collarettes. Treat both diseases accordingly and simultaneously.<\/p>\n Meibomian Gland Dysfunction:\u00a0<\/strong>Patients will often have a more recalcitrant variant of meibomian gland dysfunction, and ocular rosacea can precede facial rosacea.5<\/sup>\u00a0This is another reason we need to be well versed because optometrists often diagnose rosacea before other health care providers. Incorporate a\u00a0SPEED questionnaire<\/a><\/strong>\u00a0to easily identify symptoms. Push on meibomian glands diagnostically to properly evaluate their function.<\/p>\n Treatment for rosacea and ocular rosacea aims to control symptoms, reduce the associated inflammation, and improve overall quality of life. These patients often have psychosomatic issues because of appearance. I\u2019ve had many patients who were incredibly self conscious about how they appeared, which can also lead to depression and anxiety. While there is no cure for rosacea, there are a number of ways to effectively manage symptoms. It\u2019s important for patients to understand the chronicity of the disease.<\/p>\n Rosacea and ocular rosacea are chronic conditions that can affect the well-being of our patients, their ocular health, and ultimately their vision. The chronicity of the disease requires us to be diligent in managing patient expectations, their symptoms, as well as understanding the comorbidities that can be associated with rosacea and treating those simultaneously.<\/p>\n The exact cause of rosacea remains unknown, but it is very common in our patient populations. We can all educate our patients about lifestyle factors, which can be modified to include the avoidance of environmental triggers. Sunscreen can easily be adopted into daily routines. Treatment options exist that many of us utilize in our own clinics through IPL or that we can comanage with our optometric colleagues that have IPL technology.<\/p>\n Our patients will be more effectively managed, better educated and potentially have a better quality of life if we as optometry embrace and expand our understanding of this frustrating disease.<\/p>\n <\/p>\n References<\/p>\n 1 Van Zuuren EJ.\u00a0Rosacea<\/a><\/strong>. N Engl J Med<\/em>. 2017 Nov 2;377(18):1754-1764. doi: 10.1056\/NEJMcp1506630. PMID: 29091565.<\/p>\n 2 Zhang H, Tang K, Wang Y, Fang R, Sun Q.\u00a0Rosacea Treatment: Review and Update<\/a><\/strong>. Dermatol Ther<\/em> (Heidelb). 2021 Feb;11(1):13-24. doi: 10.1007\/s13555-020-00461-0. Epub 2020 Nov 10. PMID: 33170491; PMCID: PMC7858727.<\/p>\n 3 Gonzalez-Hinojosa D, Jaime-Villalonga A, Aguilar-Montes G, Lammoglia-Ordiales L.\u00a0Demodex and rosacea: Is there a relationship?<\/a><\/strong>\u00a0Indian J Ophthalmol<\/em>. 2018 Jan;66(1):36-38. doi: 10.4103\/ijo.IJO_514_17. PMID: 29283119; PMCID: PMC5778578.<\/p>\n 4 Andreas M, Fabczak-Kubicka A, Schwartz RA.\u00a0Ocular rosacea: an under-recognized entity<\/a><\/strong>. Ital J Dermatol Venero<\/em>l. 2023 Apr;158(2):110-116. doi: 10.23736\/S2784-8671.23.07484-4. PMID: 37153945.<\/p>\n 5 Ooi KG, Watson SL.\u00a0Rosacea Meibomian Gland Dysfunction Posterior Blepharitis May Be a Marker for Earlier Associated Dyslipidaemia and Inflammation Detection and Treatment with Statins<\/a><\/strong>. Metabolites<\/em>. 2023 Jun 30;13(7):811. doi: 10.3390\/metabo13070811. PMID: 37512518; PMCID: PMC10384312.<\/p>\n 6 Van Zuuren EJ, Fedorowicz Z, Tan J, et al.\u00a0Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments<\/a><\/strong>. Br J Dermatol<\/em>. 2019;181(1):65\u201379<\/p>\n 7 Loyal J, Carr E, Almukhtar R, Goldman MP.\u00a0Updates and Best Practices in the Management of Facial Erythema<\/a><\/strong>. Clin Cosmet Investig Dermatol<\/em>. 2021 Jun 8;14:601-614. doi: 10.2147\/CCID.S267203. PMID: 34135612; PMCID: PMC8197440.<\/p>\n <\/p>\n<\/div>\nUNDERSTANDING ROSACEA AND OCULAR ROSACEA<\/strong><\/h4>\n
SYMPTOMS OF ROSACEA<\/strong><\/h4>\n
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COMMON COMORBIDITIES<\/strong><\/h4>\n
TREATMENT OPTIONS FOR ROSACEA AND OCULAR ROSACEA<\/strong><\/h4>\n
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