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Primary and Secondary Causes of Ocular Rosacea
Topics Discussed Below
- Flushing is the primary cause of rosacea
- Flushing can adversely affect the eye surface
- Flushing can adversely affect the eyelids
- Secondary causes of ocular rosacea
- Abnormality in meibomian gland activity
- Abnormality in the quantity and quality of tears
- Abnormality in goblet cell number and function
I. Flushing is the
Primary cause of Ocular Rosacea
Eye specialists indicate
that ocular rosacea is primarily caused by frequent flushing and
vascular dysfunction. (1-15)
1. Flushing can adversely
affect the Eye Surface
- Frequent flushing disturbs the tear film of the
- Frequent flushing causes inflammation on the
eye surface due to penetration of inflammatory cells and cytokines
through blood vessels. (16, 17)
- Frequent flushing activates sensory nerves on
the eye surface and triggers burning sensations.
2. Flushing can adversely
affect the Eyelids
- Frequent flushing causes substantial damage to
the blood vessels of the eyelids.
- Frequent flushing causes swelling of the eyelids.
- Frequent flushing alters the production of oil
from meibomian glands. (19)
II. Secondary Causes
of Ocular Rosacea
Eye specialists also stress
that abnormalities in meibomian gland activity, tear secretion and
goblet cell activity can worsen ocular rosacea.
1. Abnormality in
Meibomian Gland Activity
Many ocular rosacea
sufferers experience meibomian gland dysfunction. (1, 5)
Rosacea sufferers may experience meibomian gland hyperactivity
- Hypersecretion of oil. Under
these conditions, excessive amounts of oil are produced from
the meibomian glands. Excess oil secretion can cause inflammation
on the eye surface and within the eyelid. (5, 20-23)
- Hyposecretion of oil. Under
these conditions, too little oil is produced from meibomian
glands. This usually results from inflammation or blockage of
the meibomian gland pores. (5, 20-23) A thin, unstable
layer of oil allows the water layer beneath to evaporate very
quickly. (24) Without a normal oil layer, the tear film
can lose water up to 20 times faster!
One of the tell-tale
signs of meibomian gland dysfunction is that eye irritation and
burning usually get better as the day progresses. An ophthalmologist
is able to diagnose meibomian gland dysfunction by examining the
eyelids and meibomian gland secretions.
2. Abnormality in
the Quantity and Quality of Aqueous Tears
Many studies indicate
that rosacea sufferers may not produce enough tears, or that tear
composition may be abnormal:
- In a study of 131 ocular rosacea sufferers, many
were found to have decreased tear production. (1)
- In a study of 60 patients with ocular rosacea,
Dr. Lemp and colleagues found that almost 40% of the patients
did not produce adequate amounts of aqueous tear. (25)
- In a controlled study of 14 ocular rosacea sufferers,
abnormalities in aqueous tear production/turnover were demonstrated
in most sufferers. (18)
Some people do not produce enough tears to keep the eye surface
comfortable. Others do not produce a good quality tear. Either
of these abnormalities may lead to dry eye syndrome. One of the
tell-tale signs of dry eye syndrome is that the sufferer usually
experiences gritty irritation or burning of the eyes that gets
worse as the day progresses. An ophthalmologist can diagnose dry
eye syndrome by examining the eyes. In some cases, ophthalmologists
may need to perform tests that measure tear production. One test,
called the Schirmer tear test, involves placing filter paper strips
under the lower eyelids to measure the rate of tear production
under various conditions. Another test uses a diagnostic drop
(fluorescein or Rose Bengal) to look for certain staining patterns.
3. Abnormality in
Goblet Cell Number and Function
The surface of the eye
normally contains thousands of mucous-producing goblet cells.
Studies indicate that a substantial number of rosacea sufferers
may have decreased goblet cells or impaired goblet cell activity.
(17, 26) Mucous is central to stabilizing the tear film layer,
so any abnormality in goblet cell number or function could cause
eye symptoms in rosacea sufferers.
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