Ocular Rosacea:
Other Factors that Contribute to Ocular Rosacea

Topics Discussed Below

• Other factors that contribute to ocular rosacea
  
• Bacterial abnormalities
  
• Yeast abnormalities
  
• Food and cosmetic allergies
  
• References
  

I. Other Factors that Contribute to Ocular Rosacea

Ocular rosacea symptoms can be worsened by bacterial changes, fungal changes, and allergies.

1. Bacterial Abnormalities

Increased bacteria along the eyelid margin are noted in some ocular rosacea sufferers. (1, 8)  These bacteria break down lipid secretions from the meibomian glands into inflammatory by-products that may irritate the ocular surface. Physicians can swab the outer eyelid surface of rosacea sufferers to determine if there are any bacterial abnormalities present.

2. Yeast Abnormalities

In a recent article, "Ocular Rosacea: Current Concepts and Therapy", Dr. Kligman points out that many ocular rosacea sufferers have seborrheic dermatitis of the eyelids. (27)   In fact, in most rosacea patients who have seborrheic dermatitis of the scalp, eyebrows, or center of the face, it is safe to say that these sufferers have some involvement of yeast in their ocular symptoms. (27)  One of the tell-tale signs of seborrheic dermatitis of the eyelids is that there are thick, greasy scales on the eyelashes close to the eyelid margin. (8)  Seborrheic dermatitis can aggravate rosacea symptoms by clogging up the meibomian glands and triggering inflammation of the eyelid. Physicians can swab the outer eyelid surface of rosacea sufferers to determine if there are any yeast abnormalities present.

3. Food and Cosmetic Allergies

Food Allergies. Allergic reactions to food can affect the external eye and eyelid by causing vascular flushing, and triggering mast cell activation. (28) These can cause ocular irritation, hyper-irritability, itching, burning and swelling of the eyelid. (28)  All ocular rosacea sufferers should look for a correlation between food intake and aggravation of eye symptoms.

Cosmetic Allergies. The delicate eye area is extremely susceptible to cosmetic allergens. (29) Common allergens include mascara, eyeliner, eye shadow, and eye makeup removers. (30) Allergic reactions can cause flushing of the ocular surface, ocular irritation, and eyelid inflammation. (30)

II. References

1. Akpek, E.K., A. Merchant, V. Pinar, and C.S. Foster. Ocular rosacea: patient characteristics and follow-up. Ophthalmology 104: 1863-1867, 1997.
   
   
2. Browning, D.J. and A.D. Proia. Ocular rosacea. Surv Ophthalmol 31: 145-158, 1986.
   
   
3. Dahl, M.V. "Rosacea: red faces and adult acne, and red faces". Skin Care Today 5: 1999.
   
   
4. Chen, D.M. and D.L. Crosby. Periorbital edema as an initial presentation of rosacea. J Am Acad Dermatol 37: 346-348, 1997.
   
   
5. Driver, P.J. and M.A. Lemp. Meibomian gland dysfunction. Surv Ophthalmol 40: 343-367, 1996.
   
   
6. Barton, K., A. Nava, D.C. Monroy, and S.C. Pflugfelder. Cytokines and tear function in ocular surface disease. Adv Exp Med Biol 438: 461-469, 1998.
   
   
7. Wilkin, J.K. Rosacea. Pathophysiology and treatment. Arch Dermatol 130: 359-362, 1994.
   
   
8. Donshik, P.C., D.M. Hoss, and W.H. Ehlers. Inflammatory and papulosquamous disorders of the skin and eye. Dermatol Clin 10: 533-547, 1992.
   
   
9. Starr, P.A.J. and A. McDonald. "Oculocutaneous aspects of rosacea". Proc Roy Soc Med 62: 9-11, 1969.
   
   
10. Macsai, M.S., M.J. Mannis, and A.C. Huntley. "Acne Rosacea". In: Eye and Skin Disease, edited by M.S. Macsai, M.J. Mannis, and A.C. Huntley. Philadelphia: Lippincott-Raven, 1996, p. 335-341.
    
    
11. Jenkins, M.S., S.I. Brown, S.L. Lempert, and R.J. Weinberg. Ocular rosacea. Am J Ophthalmol 88: 618-622, 1979.
    
    
12. Frucht-Pery, J., E. Sagi, I. Hemo, and P. Ever-Hadani. Efficacy of doxycycline and tetracycline in ocular rosacea. Am J Ophthalmol 116: 88-92, 1993.
    
    
13. Culbertson, W.W., A.J. Huang, S.H. Mandelbaum, S.C. Pflugfelder, G.T. Boozalis, and D. Miller. Effective treatment of phlyctenular keratoconjunctivitis with oral tetracycline. Ophthalmology 100: 1358-1366, 1993.
    
    
14. Quarterman, M.J., D.W. Johnson, D.C. Abele, J.L.J. Lesher, D.S. Hull, and L.S. Davis. Ocular rosacea. Signs, symptoms, and tear studies before and after treatment with doxycycline. Arch Dermatol 133: 49-54, 1997.
    
    
15. Hoang-Xuan, T., A. Rodriguez, M.M. Zaltas, B.A. Rice, and C.S. Foster. Ocular rosacea. A histologic and immunopathologic study. Ophthalmology 97: 1468-1475, 1990.
    
    
16. Fukagawa, K. and et al. "Chemokine production in conjunctival epithelial cells". In: Lacrimal Gland, Tear Film, and Dry Eye Syndromes 2, edited by Sullivan and et al. New York: Plenum Press, 1999, p. 471-478.
    
    
17. Pisella, P., F.Brignole, C. Debbasch, PA Lozato, C.Cruezot-Garcher, J.Bara, P.Saiag, JM Warnet, and C Baudouin. Flow cytometric analysis of conjunctival epithelium in ocular rosacea and keratoconjunctivitis sicca. Ophthalmology 107(10): 1841-1849, 2000.
    
    
18. Barton, K., D.C. Monroy, A. Nava, and S.C. Pflugfelder. Inflammatory cytokines in the tears of patients with ocular rosacea. Ophthalmology 104: 1868-1874, 1997.
    
    
19. Stern, M.E., R.W. Beuerman, R.I. Fox, J. Gao, A.K. Mircheff, and S.C. Pflugfelder. A unified theory of the role of the ocular surface in dry eye. Adv Exp Med Biol 438: 643-651, 1998.
    
    
20. Bron, A.J., L. Benjamin, and G.R. Snibson. Meibomian gland disease. Classification and grading of lid changes. Eye 5 ( Pt 4): 395-411, 1991.
    
    
21. McCulley, J.P. and W.E. Shine. Meibomian secretions in chronic blepharitis. Adv Exp Med Biol 438: 319-326, 1998.
    
    
22. Bron, A.J. and J.M. Tiffany. The meibomian glands and tear film lipids. Structure, function, and control. Adv Exp Med Biol 438: 281-295, 1998.
    
    
23. McCulley, J.P., J.M. Dougherty, and D.G. Deneau. Classification of chronic blepharitis. Ophthalmology 89: 1173-1180, 1982.
    
    
24. Tsubota, K. Tear dynamics and dry eye. Prog Retin Eye Res 17: 565-596, 1998.
    
    
25. Lemp, M.A., M.A. Mahmood, and H.H. Weiler. Association of rosacea and keratoconjunctivitis sicca. Arch Ophthalmol 102: 556-557, 1984.
    
    
26. Pflugfelder, S.C., S.C. Tseng, K. Yoshino, D. Monroy, C. Felix, and B.L. Reis. Correlation of goblet cell density and mucosal epithelial membrane mucin expression with rose bengal staining in patients with ocular irritation. Ophthalmology 104: 223-235, 1997.
    
    
27. Kligman, A.M. Ocular rosacea. Current concepts and therapy. Arch Dermatol 133: 89-90, 1997.
    
    
28. Bonini, S. Mechanisms in adverse reactions to food. The eye. Allergy 50: 68-73, 1995.
    
    
29. De Groot, A.C. Fatal attractiveness: the shady side of cosmetics. Clin Dermatol 16: 167-179, 1998.
    
    
30. De Groot, A.C., J.W. Weyland, and J.P. Nater. "Percutaneous absorption of topically applied drugs". In: Unwanted Effects of Cosmetics and Drugs Used in Dermatology, edited by A.C. De Groot, J.W. Weyland, and J.P. Nater. New York: Elsevier, 1994, p. 226-523.

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