Rosacea is a chronic dermatologic disease that most often affects the face and surrounding ocular tissues. It is characterized by facial flushing (erythema), telangiectasia, roughening of the skin, and inflammatory pustules on the skin surface. The differential diagnosis for Rosacea includes acne vulgaris, contact dermatitis, seborrheic dermatitis, eczema, sarcoidosis, lupus, perioral dermatitis, and some drug induced photoreactions.

There are 4 types of Rosacea including Erythematotelangiectatic Rosacea which is characterized by dilation of multiple blood vessels and telangiectasia. Papulopustular Rosacea demonstrates with skin pimples and plaques and Phymatous Rosacea which presents with phymas and tissue hyperplasia. The final types and most frequently seen is Ocular Rosacea. This type is characterized by multiple ocular signs and always exhibits exacerbations and remissions.

Ocular signs for Ocular Rosacea present prior to skin manifestations in as many as 20% of the cases. The cause of the inflammation is most often Staphylococcus exotoxins and ocular surface inflammation is the most common complication . Signs include dry eyes, telangiectasia of the lid margins, conjunctivitis, blepharitis, Chalazia, Hordeola, Meibomianitis and Keratitis. The glands of Zeiss and Moll may also be affected and complicate tear production.

Rosacea occurs in 4 distinct stages and starts with Prerosacea which includes skin flushing and recurrent episodes of facial redness. Triggers such as sunlight, alcohol, tobacco, spicy foods and stress will exacerbate the condition. Stage 1 includes the prerosacea signs plus telangiectasia which is permanent blood vessel dilation, and prominent sebaceous glands resulting in oily skin. Stage 2 adds on swelling of the skin tissue, papules, pustules, and enlarged pores. Stage 3 results in tissue hyperplasia, rhinophyma and enlargement of the sebaceous glands on the nose.

Initial treatment includes warm compresses to the lids, non-preserved artificial tears and oral doxycyclines for 6 weeks. In addition, patients are advised to avoid the previously mentioned triggers. The incidence of this disorder is approximately 1 in every 20 Americans or about 14 million individuals.

Treatment of Ocular Rosacea will depend on the types and severity of the condition. Therapy includes lid hygiene with warm compresses and lid scrubs. Artificial non preserved tears must be employed as are soft topical steroid eye drops. Restasis in often used to increase tear production and now topical antibiotics such as Azasite are frequently used. Oral antibiotics like Doxycycline have always been a standard treatment and co management with the patient's primary care physician or dermatologist is recommended. In severe cases surgical intervention is required to treat lid and corneal disease.

In short, Ocular Rosacea is a common disorder that can affect the health of the eye and therefore the vision. Aggressive therapy must be administered and managed to ensure life long vision.