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Eye rosacea is a subtype of rosacea, a common chronic skin condition. Eye rosacea, although often mild, should be treated promptly to prevent rare complications that can cause loss of vision.

What is rosacea

Rosacea is a common skin condition that mainly affects light-skinned people between 30 and 50. It causes facial redness, which looks similar to blushing, but is more persistent. This phase can last for years without progressing. In others the redness gets worse, blood vessels in the skin become visible and raised areas of thickened skin can develop. Thickened skin can be particularly severe on the nose.

Rosacea was thought to be caused by a bacterial infection but now most experts believe it is a multifactorial inflammatory response. There may be an initial infection of the skin, and antibiotic treatment is often effective at reducing the symptoms. A combination of environmental and genetic factors may interact to increase the risk of rosacea and the following have been suggested:

  • Genetic susceptibility: rosacea can run in families. It is thought that there may be a genetic link, but no genes have yet been identified.
  • Blood vessel abnormalities: these may be a major factor in rosacea, explaining many of the features, but why they would occur is not known.
  • Demodex folliculorum: this is a microscopic mite that lives harmlessly on skin but it has been found in higher numbers in people with rosacea. It is possible that it blocks oil glands.
  • Sun damage: this could damage blood vessels.
  • Abnormal immune reactions in the skin.
  • Helicobacter pylori: this bacterium is found in the digestive system of some people and it is known to increase the risk of stomach ulcers. It is thought possible that the bacterial infection stimulates production of the bradykinin protein, which causes blood vessels to dilate and this could affect the skin.
  • Migraines: people who experience regular migraines may be more prone to rosacea, perhaps because of blood vessel abnormalities.

Around half of all people who develop skin rosacea also develop eye rosacea.

Eye rosacea: signs and symptoms

Eye rosacea usually develops with skin symptoms, but sometimes it is possible to have it alone. Why some people with skin rosacea develop eye rosacea is not known. Although skin rosacea is mainly diagnosed in women, eye rosacea affects men and women equally. The severity of skin symptoms may not always match how badly the eyes are affected by rosacea. Symptoms and complications of eye rosacea include:

  • Irritation or itchiness
  • A feeling as if there is a foreign body in the eye
  • Dry eyes or watering eyes
  • Blurring of vision
  • Visible small blood vessels in the white of the eye
  • Eyes feel that they are stinging or burning
  • Discomfort in bright conditions
  • Blepharitis: reddening or swelling of the eyelids and other eyelid problems including styes
  • Red, sore eyelids, possibly conjunctivitis
  • The oil-producing meibomian glands inside the eyelid can become blocked causing secretions to build up
  • Inflammation, ulceration and scarring of the cornea: keratitis can lead to loss of vision and should be treated by a specialist promptly

What triggers rosacea and eye rosacea?

Although the underlying causes of rosacea and eye rosacea are not known, several triggers that make both conditions worse have been identified:

  • Being in a hot environment and moving into the cold, and vice versa
  • Alcohol, particularly red wine
  • Caffeine in coffee, cola and other caffeinated drinks
  • Spicy foods and hot drinks
  • Strenuous exercise
  • Sunlight
  • Some skincare products
  • Emotional stress
  • Medications that dilate blood vessels, including some used to treat high blood pressure can also be a trigger
  • Humidity
  • Hot baths
  • Dairy products
  • Coughs, colds, fevers and other conditions

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