Finding Out I Have Ocular Rosacea

Oddly enough, a telehealth visit gave me a more important insight into my chronic dry eye than any of my office visits last year.

Before I had my virtual consult with dry eye specialist Dr. Laura Periman, she asked for cell phone photos of my eyes—close up. I can’t say I really enjoyed taking or looking at these photos, but I understood it was necessary to get some initial ideas about what may be causing my chronic dry eye and how severe it is.

Ocular rosacea

The first thing Dr. Periman said to me when we started the consult was “has anyone ever told you you have ocular rosacea?” I had heard of this, but it was still a surprise to me. Thinking about those photos, it started to make sense. My eyelids looked so red all the time. My local dry eye doctor noted I have tiny inflamed blood vessels along my eyelids (known as telangiectasia). These are a common sign of rosacea.¹

After that appointment I was visiting my parents and mentioned the diagnosis, and my mom said “rosacea, that’s what’s all over your dad’s face.” Oh really? Somehow I’d never made the connection. This meant I have a genetic connection to the rosacea Dr. Periman observed around my eyes.

But what does this common rosy-cheeked skin condition have to do with dry eyes? After some reading I learned that rosacea can be a major factor for chronic dry eye, because it increases inflammation around the eyes, which makes it harder for the oil glands along your eyelids to function properly.² This could also explain why so many of my oil glands have stopped working completely.

Contributing factors and triggers

When I finally made it up to Seattle for an office visit with Dr. Periman, another thing she did was pluck a few eyelashes to look for tiny skin mites called Demodex. Under the microscope, she showed me a few of them lurking at the base of my eyelash. These mites are thought to be another contributing factor for ocular and facial rosacea, and several other eye diseases that are linked with chronic dry eye.³

Another thing I learned was that there are common dietary triggers that will make rosacea flare up. Every time my face flushes after a couple of drinks—-that’s rosacea. Unfortunately alcohol is a common trigger, along with chocolate, tomatoes, citrus fruits, spicy food, and caffeine. I’ve avoided some of these, but I haven’t noticed my morning coffee making me flush, so I’ve decided not to give it up.⁴

I’ve also learned that hot showers, intense exercise, and being out in the sun or the cold too long trigger my rosacea. While some of these (like exercise) benefit my health, I can do without a really hot shower and wear sunscreen and hats more reliably when I’m outside hiking or running.

Intense pulsed light

The good news is, there are treatments that can help keep rosacea under control. Dr. Periman recommended a treatment called IPL, which is short for Intense Pulsed Light. This treatment started out in dermatology but has been FDA approved for use around the eyes. Studies show that IPL treatments reduce the visible signs of rosacea, and Dr. Periman believes it also reduces inflammation in the eyelids that contributes to so many of my dry eye symptoms.⁵

As of writing this, I have had the standard course of 4 IPL sessions and I have noticed a big decrease in my dry eye symptoms. Whether it’s from just the IPL or a combination of everything I’ve done lately, I’m not sure, but I'll take it.

It’s certainly not the most comfortable treatment experience (read Erica’s IPL experience here), but it’s been worth it to me. Rosacea is something I plan to keep under control as much as possible, for the sake of my eyes.