Ocular rosacea

Ocular rosacea is the manifestation in the eyes of rosacea, a chronic relapsing inflammatory skin condition that predominantly affects the cheeks, nose and forehead. It occurs in up to one in twenty people with peak incidence between the ages of 40 and 60. Patients can experience discomfort, dryness, photophobia and even blurred vision if the cornea is involved. Other clinical entities that are associated with rosacea such as blepharitis, tear film abnormalities and keratitis may be present. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating ocular rosacea. It provides recommendations for non-pharmaceutical management and pharmacological treatment, and highlights the need for urgent referral if keratitis is severe.

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What is ocular rosacea?

Rosacea is a common skin disorder, affecting up to one in twenty people between the ages of 40 and 60, that can also affect the eye. It causes redness of the nose, forehead and upper cheeks, along with inflammation of the oil glands of the skin. Around a half of rosacea patients have eye involvement, with symptoms of discomfort, dryness and light sensitivity. The optometrist may find inflammation of the eyelids (blepharitis) and abnormalities of the tear film (the thin layer of tears covering the surface of the eye) which cause patchy drying of the eye surface. This can cause inflammation of the cornea (the clear window at the front of the eye) with thinning, ulceration, ingrowth of abnormal blood vessels and scarring, all of which can lead to reduced vision.

How is ocular rosacea managed?

Dietary advice may help, as may attention to the inflammation of the eyelids. Artificial tears and lubricating ointments may relieve discomfort. An antibiotic given by mouth, usually a drug from the tetracycline family, can improve the condition of both the skin and the eyes. If the condition does not respond to simple measures such as these, the optometrist will refer the patient to the ophthalmologist, who may consider prescribing other drugs and may possibly recommend surgery.

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Last updated

Ocular rosacea
Version 12
Date of search 16.03.24
Date of revision 02.05.24
Date of publication 10.06.24
Date for review 15.03.26
© The College of Optometrists