Eyeworld

EW NEWS & OPINION 24 March 2016 by Matt Young and Gloria Gamat EyeWorld Contributing Writers earlier reports using different diag- nostic criteria. Rosacea: Correlation with ocular findings In the December 2015 issue of Current Eye Research, Machalinska and colleagues reported the results of the first study to quantify mei- bomian gland dropout in rosacea patients. "In the rosacea group, we noted a negative correlation between ocular symptom scores and tear film breakup time (TBUT) (rs=−0.33, p=0.002); this finding confirms a direct relationship between dry eye symptom intensity and tear film stability in those patients," reported More known now about how rosacea affects eyes A lthough categorized medically as a skin condi- tion, plenty of evidence supports the fact that acne rosacea can cause in- flammation of the eyelid and ocular surface. Most patients with ocular rosa- cea have meibomian gland dysfunc- tion (MGD) and inflammation of the ocular surface in varying degrees of severity (i.e., on the lids, conjunc- tiva, sclera/episclera, and/or cornea). Experts currently think that half or more of rosacea patients have ocular involvement, in contrast to Ocular involvement in rosacea patients Tips for dealing with ocular rosacea F rancis Mah, MD, director of corneal and external disease and co-director of refractive surgery, Scripps Clinic, La Jolla, Calif., weighed in on this issue as well. "Rosacea in general is inflammation around the sebaceous glands of the skin," he said. "Meibomian glands anatomically are sebaceous glands but in the eyelid." "In general, dermatologists treat rosacea," he said. But the way they might treat ocular involvement typically starts with systemic tetracycline derivatives like minocycline and doxycycline. Ophthalmologists, meanwhile, primarily treat the eye component. Sometimes the ocular component is more concerning and symptomatic than the systemic for a patient, especially if it becomes very symptomatic. Here are Dr. Mah's tips for dealing with ocular involvement of rosacea, which might be the root cause of meibomian gland dysfunction and/or blepharitis: • At least 5–10 minutes warm compresses is ideal. A bean bag or gel mask heated up in the microwave does the trick for many patients. While some people use a wash cloth heated with warm or hot water, the cloth loses heat quickly. Even boiled eggs or potatoes can do a better job than cloth, he said. Heated tea bags also can be of use. While some attribute ocular benefits to the tea antioxidants, Dr. Mah thinks it's just the warmth that's probably the main beneficial contributor. • Lid cleaning is essential. "The key is to express the meibomian glands," he said. Mechanically removing thicker oils deposited on the lashes and the bacteria colonizing the oils that are associated with blepharitis is important. • Avenova (NovaBay Pharmaceuticals, Emeryville, Calif.) and Cliradex (Bio-Tissue, Doral, Fla.) are commercial products that might be beneficial. • If there is accompanying facial rosacea, either extended release doxycycline 20 mg twice per day or minocycline 50 mg once a day works well. Minocycline may be preferable due to once-a-day usage and the fact that there are some sensitivity issues with doxycycline and sun. Azithromycin orally or topically has also been show to have therapeutic benefit. EW Editors' note: Dr. Mah has no financial interests related to his comments. Contact information Mah: Mah.Francis@Scrippshealth.org Patient with rosacea Source: Francis Mah, MD "In the rosacea patients, we observed a higher frequency of lid margin telangiectasia, rounding of the posterior lid margin, notching of the lid margin, orifices retroplace- ment, eyelash loss, trichiasis, and anterior blepharitis compared to control participants," the researchers said. "Likewise, the frequency of bul- bar hyperemia and corneal epithelial loss were also found to be signifi- cantly higher in those patients." While earlier studies did not have a standard method of defining the signs and symptoms of rosacea patients with ocular manifestations, it became generally accepted that lid disease-related complaints are the most common clinical presentation. According to a study by Ghanem and colleagues, the most common ocular signs in patients with rosacea from the ophthalmologic clinic were MGD (85.2%), lid margin telangiectasias (53.4%), blepharitis (44.3%), and interpalpebral hyperemia (40.9%). "Accordingly, patients from the dermatology clinic were reported to exhibit MGD (27.3%), chalazion/ hordeolum (27.3%), lid margin telangiectasia (18.2%), anterior blepharitis (13.6%), and pinguecula (13.6%)," they reported. Machalinska and colleagues' ob- servation that skin rosacea patients demonstrated significantly higher lid margin abnormality, lid margin telangiectasia, rounding of the pos- terior lid margin, notching of the lid margin, eyelash loss, trichiasis, and anterior blepharitis compared with the control participants is Anna Machalinska, PhD, Depart- ment of Histology and Embryology, Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland, the study's lead investigator. "Remarkably, we noticed a positive correlation between lid margin abnormality and the extent of meibomian gland dropout in ro- sacea group (rs=+0.30, p=0.005); this result suggests there is a relationship between ocular rosacea signs and abnormalities in meibomian gland morphology," the researchers added. The association of rosacea with MGD has been suggested by earlier reports, according to the researchers. To confirm this further, they ana- lyzed the meibomian gland function and morphology and evaluated lid margin alterations. "We found that lid margin abnormality was significantly higher in the rosacea group compared to healthy volunteers (p<0.0001). Interestingly, the highest lid mar- gin abnormality values were ob- served in papulopustular rosacea and hyperglandular-hypertrophic rosacea patients; this finding implies that higher lid margin abnormality values were observed in patients with more advanced subtypes of the disease," they explained. Prevalence of lid margin abnormalities Other statistically significant associ- ations found may suggest that skin rosacea is an independent predictor of lid margin abnormalities.

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