Ocular Rosacea: Causes, Symptoms, and Relief

ocular rosacea

Ocular rosacea is often mistaken for other eye-related concerns such as blepharitis, dry eye, or meibomian gland dysfunction (MGD). About 20% of people with rosacea show ocular symptoms before developing any skin symptoms, which often causes this type of rosacea to be overlooked or misdiagnosed. 

This article helps you understand the symptoms and take the necessary measures at an appropriate time. We also help you know more about ocular rosacea causes and risk factors (including Demodex mites) to prevent recurrence and progression.

What Is Rosacea?

Rosacea is a prevalent chronic skin disorder with varying manifestations and severity. The condition mainly affects the skin’s blood vessels, follicles, and sebaceous glands. Although rosacea can affect different parts of the skin, it is usually confined to the central part of the face (cheeks, chin, nose, and central forehead). This condition causes transient or persistent redness, broken capillaries and dilated blood vessels, pimple-like bumps, rough skin, and an enlarged nose

What Is Ocular Rosacea?

Although rosacea is mainly considered a skin problem, 58 to 72% of sufferers undergo various eye complications, including eyelid inflammation and discomfort in the eyes. About one-third of patients also develop corneal involvement, which can affect their vision. The rosacea that affects the eye is called ocular rosacea. As mentioned, in 20% of people, eye-related signs may appear before any skin symptoms, making it difficult to diagnose.

Persistent, untreated ocular rosacea may lead to varying degrees of eye complications, eyelid deformities, emotional and social suffering. Due to the negative impact of this condition on individuals’ quality of life and its potentially threatening visual effects, it is necessary to increase people’s knowledge about the symptoms, complications, and control of this complication.

Who Gets Rosacea?

Rosacea has been diagnosed in more than 16 million Americans, and Swedish research has shown a prevalence of up to 10%.

Women are more likely to get rosacea and are usually diagnosed earlier. A possible explanation for this is that women may seek medical care sooner than men. Men, on the other hand, are more prone to rosacea-related changes in the nose. These changes, which are accompanied by large, rough, uneven skin and bumps on the nose, are called “rhinophyma” and are more common in men over 40 in the more advanced stages of the disease. However, ocular rosacea affects both sexes equally. Rosacea may affect people of any age, including kids and old people, but it mostly affects middle-aged people.

Although rosacea is common in all ethnicities, people with fair skin and of European descent are more likely to get rosacea.

Ocular Rosacea Symptoms

Although rosacea, in general, causes redness and inflammation, this article specifically examines the ocular rosacea symptoms. For more information about cutaneous rosacea and the products that help you control it, delve into this link.

Symptoms of ocular rosacea include:

  • Foreign body sensation in eyes
  • Dry eyes
  • Blepharitis
  •  Itchy eyes
  •  Photophobia and tears
  •  Impaired vision (in case of corneal involvement)

Ocular manifestations usually affect both eyelids and can be identical to other ocular issues. Meibomian glands dysfunction, the major cause of evaporative dry eye, is common in ocular rosacea. This disorder can lead to changes in the tear film composition, resulting in dry eyes, telangiectasia (commonly known as “spider veins”), dilated eye vessels, dilated meibomian glands, and blepharitis. Conjunctival hyperemia and swelling are other symptoms. In acute conditions, ocular rosacea can lead to corneal perforation.

What Causes Rosacea?

The exact cause and pathophysiology of rosacea, both cutaneous and ocular, remain largely unknown. But different theories have been proposed in this regard:

Rosacea and Inflammation

Some studies have investigated the tear fluid composition of ocular rosacea patients, revealing its high inflammatory factors compared to normal individuals’ tears. So, rosacea, including the ocular type, seems to be an inflammatory disorder.  However, in recent years, it has become evident that some external factors, such as lifestyle, certain stimuli, and weather conditions, can exacerbate or trigger this inflammation. Some researchers have also found that people with rosacea respond more strongly to stimulation than usual. Moreover, their immune system may be overactive and release more inflammatory agents, leading to exacerbated rosacea. Some of the environmental factors that trigger cutaneous and ocular rosacea are sunlight, pressure, heat, alcohol (especially red wine), spicy foods, some skin and hair care products, cosmetics, wind and cold, some medicines, exercising, etc

Vascular Disorders

Dilation and chronic venous insufficiency contribute to the rosacea manifestations. Studies show increased blood flow in the face compared to other parts of the body. Moreover, in patients who undergo ocular and cutaneous rosacea, blood vessels and lymphatic vessels dilate significantly, leading to the face and eyes becoming bloody, red, and inflamed.

Genetic Disorders

In addition to inflammation and vascular issues, heredity greatly influences rosacea development and flare ups. Some genetic factors change the arteries, leading to hyperemia of the eyes and face and some other symptoms of rosacea.


Some microbes such as Helicobacter pylori, Demodex mites, and Staphylococcus epidermidis are other possible factors in exacerbating the condition.

Helicobacter pylori

The prevalence of Helicobacter pylori infection is higher in patients with rosacea compared to the general population. On the other hand, eradication has been shown to affect the clinical outcome of the disease. Helicobacter pylori is one of the bacteria that has a role in digestive problems. This bacterium causes ulcers in the stomach and intestines. It also causes excessive dilation of blood vessels and intensification of redness of the eyes and skin by overproduction of some hormones.

Staphylococcus Epidermidis

Staphylococcus epidermidis is another microorganism that has a role in the pathogenesis of rosacea. They are the most abundant bacteria that live naturally on the skin of all human beings. This type of Staphylococcus protects the skin barrier integrity by inhibiting the growth of pathogenic bacteria – including Staphylococcus aureus.

Studies have shown that Staphylococcus epidermidis is the only bacteria present in acne-like appendages on the skin of people with rosacea. They produce inflammatory substances that stimulate the immune system and help trigger rosacea symptoms.

Demodex Mites

Demodex mites located in hair follicles and sebaceous glands are the most typical parasites in humans. They usually live in small numbers on everyone’s skin. However, studies support their role in activating immune mechanisms in different types of rosacea, especially papulopustular rosacea.

The number of Demodex is significantly higher in individuals with facial rosacea. A large number of them have also been found in the ocular-rosacea-caused discharge.

Demodex mites play a known role in causing and exacerbating blepharitis and chalazion, the two prevalent issues linked to ocular rosacea.

Beyond activating immune mechanisms, another suggested mechanism is that Demodex mites are the potential vector of some toxic microorganisms including Bacillus oleronius, the main culprit in initiating the inflammatory response in rosacea. 

Finally, Demodex parasites secrete provocative metabolites that can cause localized tissue damage, inflammation, and rosacea exacerbation.

The role of Demodex in the development and exacerbation of rosacea is so evident that sometimes large populations of them can mimic rosacea symptoms, which disappear with proper hygiene to remove the mites.

Ocular Rosacea Treatment

There is no definitive cure for cutaneous and ocular rosacea. Measures mostly include controlling symptoms and preventing progression. Meanwhile, adopting courses of action to control ocular rosacea should begin as soon as possible to prevent the irreversible change in eye tissue. These measures prevent serious complications and help the sufferers to return to normal life by controlling their symptoms.

Beyond the broad range of medical treatment, rosacea control has two important aspects:

  • Stimulus control
  • Root cause analysis

Stimulus Control

Primary management involves identifying and avoiding stimuli. These factors can usually vary from person to person. However, in general, the following elements can trigger the rosacea symptoms, including the ocular type:

  • Spicy foods or drinks
  • Alcoholic beverages
  • Sunlight
  • Wind
  • Extreme temperature change
  • Stress, anger, or embarrassment
  • Intense heavy exercise
  • Hot baths or a sauna
  • Hot foods and liquids
  • Certain medications such as cortisone creams
  • Caffeine, cheese, and chocolate

Root Cause Analysis

One of the effective measures to control rosacea is to identify the root causes and minimize as many risk factors as you can. Obviously, many of them are intractable, including genetic predisposition, vascular changes, fair skin, and immune system imbalance. However, sufferers can seek to identify other risk factors and control rosacea by keeping them under control. Manageable rosacea risk factors include: 

  • Helicobacter pylori
  • Staphylococcus epidermidis
  • Demodex mites

Medics can identify and eliminate each of the above factors in a specific way. For example,they diagnose Helicobacter pylori via stomach biopsy tests, stool antigen, and H. pylori breath tests.

Among the above controllable factors, Demodex mites have a notable role in developing and exacerbating rosacea manifestations. So, diagnosing and eliminating these mites is a great step forward in eliminating rosacea symptoms.

How to Detect Demodex Mites

There are generally two diagnostic procedures to identify Demodex mite infection in humans: microscopic testing and online testing.

Microscopic Test:

To conduct this procedure, a dermatologist removes a thin layer of the skin from the area most prone to Demodex mite activity (part of the skin that manifests the most rosacea symptoms). The laboratory scientist examines this sample under a microscope to count Demodex mites per surface unit. If the number of mites is significant (more than five per square centimetre), there is a great chance that they play a role in provoking rosacea symptoms. In this case, eliminating them is the best thing you can do to control your symptoms.

One of the best products you can use is PDT, the unique anti-Demodex spray manufactured by Ungex. However, if you undergo severe symptoms, have sensitive skin, or need to use the product on your eyelash line, SDT is a perfect choice. The product is extremely gentle on the delicate parts of the skin and does not cause irritation. Both PDT and SDT can be applied on all parts of the skin – even the eyelids and eyelash line. Just spray them on infected areas such as your scalp, skin, or even eyelids to get rid of the Demodex mites and their rosacea-mimicking symptoms. You need to do this every night for at least two months.

Demodex Online Testing:

The Demodex online diagnostic test is an accurate and trustworthy quiz to estimate Demodex mite density with a good approximation employing the symptoms they display themselves through. 

Contrary to what it seems at first, the online test is quite valid, and skips the common microscopic test errors. Demodex Mites usually seek refuge deep under the skin, hooked with their long tails to the hair bulb. So, the number of parasites one can count under a lens does not necessarily reflect their true population, while online testing does not face such a challenge.

Demodex online testing is fast, reliable, and non-invasive. It does not matter where you are, just click this link to find out your Demodex population. This test only takes you five minutes and is completely complimentary.

If the result shows medium, high, or very high density of Demodex mites on your skin, removing them will probably go a long way in improving your rosacea symptoms. 

To soothe Demodex mite symptoms, besides PDT and SDT, you can use DDC to clean your eyelids and skin. This product is a high-quality anti-Demodex cleanser that removes bacteria, viruses, and other germs in addition to Demodex mites. These germs include microbes that play an influential role in provoking rosacea manifestations. Since baby shampoo does not affect Demodex, you can use this product for routine eyelid washing, which is usually recommended as a home remedy for ocular rosacea.


Patients with Ocular Rosacea

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