Fw: [rosacea] Re: Ocular Rosacea
Ocular rosacea is a disorder that affects both the eye surface and eyelid. Some of the most common symptoms include:
. Bloodshot eyes . Burning sensations . Eye pain
. Foreign body sensations of the eye surface . Excess tearing of the eye . Hyper-sensitivity of the eye surface
. Eye irritation to wind, cold, smoke, indoor heating . Photophobia (pain and tearing of the eyes triggered by bright light). . Itching of the eye surface
. Redness, crusting, and inflammation of the eyelids. In some cases, crust may form overnight that `glues' the eyelids together. . Chalazia (inflammatory bump on the eyelid) . Stye (infla! mmation of an eyelash follicle)
. Excess discharge from the sebaceous glands of the eyelids. . Loss of eyelashes . Severe damage to the cornea and blindness
Obviously, there is a great degree of overlap with eye symptoms from allergies. It is very wise to see an eye specialist. They will run a thorough series of tests to determine the most probable cause of your symptoms, and the physician should give you some effective treatment options.
In all simplicity, ocular rosacea is a combination of dry eye and ocular inflammation. Surprisingly, relieving the dry eye symptoms usually results in substantial improvement of ocular rosacea.
One of the main complaints that occular rosacea sufferers complain of is blurry vision. In 99% of the cases this actually has nothing to do with vision loss. It has to do with a disturbance in the three layers of moisture on your eye surface (mucus, water and oil). This (! and sometimes the inflammation) plays a role. Good treatment focuses on getting back a normal tear film layer first, then seeing what happens.
ARTIFICIAL TEARS are one of the best things you can do for your eyes. While treatment for ocular rosacea is usually multifactorial, several studies have shown that daily use of artificial tears for three to four months can help the tear film stabilize by decreasing ocular irritation. Then patients can sometimes stop immediately or just use them upon flare ups. PLEASE DON'T USE VASO-CONSTRICTOR EYE DROPS! The challenge is to find the right eye drop for your eye. The eye vessels in general are a lot more forgiving then the facial vessels.
Many folks recommend Refresh Plus Drops for Sensitive Eyes. I have found great success with Thera Tears eye drops, which are preservative free.
In many cases, the normal eye drops are not strong enough. That is why the leaders in the industry have made gel drops. Several of these gel drops by themselves have been shown to improv! e the entire tear film layer, stabilize the water concentration and electrolyte balance, and reduce some forms of inflammation. Gels last 4 to 8 times longer than most normal eye drops.
Some of the newer versions of gel drops worth a try are:
1. GenTeal Eye Gel ^ Carbopol 980 gel. This is the strongest gel drop. For flat out moisturization without blurriness, Dr. Nase likes thise new preservative free gel by GenTeal.
2. Bausch and Lomb Liquid Gel ^ Hypromellose gel.
3. Systane ^ hydroxypropyl guar. This is the newest gel derivative and there is quite a bit of information on pubmed about the guar actions.
Many like the Similasan I and II drops. For those with severe dry eye, the Lacriserts placed under the eyelid at night still have no match.
Another good topical for ocular rosacea is an ointment called Lacrilube by Allergan. It is kind of thick and sticky so you won't really be able to use it! during the day. It definitely makes your eyes feel better, especial ly when they have that foreign body sensation or irritation. You put it directly in the pocket of your eyes.
If the inflammation is still severe, Doxycycline 100 mgs 2 to 4 times a day can be used. or Periostat 40 mgs. If this fails, then the mast cell inhibitor Patanol is always a good try.
Two new eye drops/suspensions continue to show promise for moderate to severe ocular rosacea.
1. 10% N-acetylcysteine drops (Mucomyst) -- This mucolytic agent can be used successfully in rosacea patients with abnormal tear film layer (mucus layer). In ocular rosacea, the superficial inflammation can alter goblet cells, which affects the production of the tear film layer. This is the first agent to address this specific problem.
2. Cyclosporine ophthalmic (Restasis) drops -- Used to relieve dry eyes caused by suppressed tear production secondary to ocular inflammation. First eye drop to actually increase natural tear produc! tion, stabilize tear film layer and resolve ocular inflammation. Restasis eye drops are available by prescription. It can take up to 3 months to see their full effect.
Oral cyclosporine can cause a number of side effects. Topical cyclosporine (restasis) should be used cautiously in moderate to severe occular rosacea patients, but it is generally much safer to use. Medical studies indicate it may be used safely long term 6 to 9 months with a low side effect profile. In many patients, it relieves the inflammation and therefore stops the tear film layer from breaking up. Regarding rosacea, it specifically blocks several classes of inflammatory cytokines on the ocular surface, which this makes the ocular surface more "healthy". If you decide to start the eye drops, follow up with your doctor and get ocular surface testing every 3 to 6 months.
Supplemental help for Dry Eyes & Ocular Rosacea
There are two new or! al products on the market for adjunctive treatment of dry eyes and oc ular inflammation. While the web sites listed below certainly are promotional, they are quite informative and are consistent with the current medical information on dry eye syndrome, ocular inflammation, and treatment of both conditions.
They both utilize essential fatty oil supplementation and one brand has added mucin to their mixture (which theoretically may help support the inner most layer of the tear film - the mucous layer). In addition to daily lid hygiene and eye drop/eye gel therapy, these might be worth a 60 day trial in those ocular rosacea sufferers with persistent problems.
1. Hydroeye Softgels. Claims to: a. Decrease ocular surface inflammation b. Stabilize tear film by thickening outer oil layer