Occular rosacea

Eye symptoms include grittiness, redness and soreness, conjunctivitis or blepharitis may occur. As a result, vision may be blurred and there can be an increased sensitivity to light. In around 5% of cases, there may be more severe damage to the eyes. It should be noted that ocular problems may occur long before there are any skin symptoms.

Whilst rosacea is a relatively common condition affecting around 10% of the population, there is little clarity about its pathophysiology. It is generally agreed that there is genetic predisposition which is aggravated by environmental factors with around 70% of cases reporting worsening when exposed to UV. Box 13.9 outlines some of the trigger factors that can worsen rosacea. The facial flushing may be caused by damage to the blood vessels which lead to vessel dilatation. There might be some association with a hair follicle mite called Demodex folliculorum as there is an increased incidence of these in rosacea papules in some people (New Zealand Dermatological Society Incorporated, 2009). It is well recognised that topical steroids aggravate rosacea and should not be used as part of the treatment. Other oil-based skin applications can also make the condition worse.

Box 13.9 Trigger factors for rosacea Heat: from ambient temperature, spicy food, hot drinks, hot showers bath UV exposure Topical steroids Oil-based moisturisers and make-up products Alcohol