Is Ocular Rosacea An Autoimmune Disease & Does It Cause Blindness?

Rosacea is a well-known skin disease frequently affecting older adults in particular. It is responsible for redness of the face along with pimples, especially on the nose and chicks in people with fair skin. Rosacea is often accompanied by blepharitis (inflammation of the free edges of the eyelid, close to the eyelashes) in 60% of the cases. The ocular involvement of rosacea is even indicative of 20% of cases where there is no manifestation on the skin.

Ocular rosacea is an inflammation that causes redness, burning, and itching of the eyes. It often develops in people with rosacea. Sometimes ocular rosacea is the first sign of possible facial rosacea. It affects mainly adults aged 30 to 50 years and it seems to develop in people who tend to blush easily.(1)

Is Ocular Rosacea An Autoimmune Disease?

Although ocular rosacea itself cannot be called an autoimmune disease, there is recent evidence to suggest that there must be some links between other autoimmune diseases and rosacea.

Rosacea may also be a hidden, visible warning sign of a potentially serious illness. According to a large population-based case-control study, female rosacea is associated with an increased risk of a variety of autoimmune diseases, including type-1 diabetes, celiac disease, multiple sclerosis, and rheumatoid arthritis. However, men with rosacea are more likely to develop rheumatoid arthritis.(2)

The Immune System May Be Involved

The occurrence of rosacea could, in fact, come from an exacerbation of the immune system influenced by exposure to UV, oxygen-free radicals, and various microbes, in particular. There may also a vascular anomaly of the face resulting in flushing and permanent erythema (rosacea). This results in permanent edema of the dermis, favoring a mite responsible for papulopustular lesions. Antimicrobial peptides (AMP) – natural proteins with antimicrobial properties – also activate the immune system, and play a key role in this condition. Furthermore, the TLR2 receptor causes an inflammatory response to vitamin D from UV rays and microbial agents upon activation. Rosacea is actually the answer to this over-demand on the immune system. Bacterial infections such as Bacillus oleronius may help trigger rosacea.(2)

Does Ocular Rosacea Cause Blindness?

Few skin diseases can disrupt life like rosacea, a painful condition that can damage vision and cause blindness. Rosacea in the eye can make your vision disturbed when subjected to light or blur your vision. When rosacea of the eye becomes severe, the cornea itself may be damaged, resulting in vision loss. Untreated rosacea in the eye can cause a rare condition called rosacea keratitis, which can lead to blindness.(3)

However, in most cases, rosacea in the eye is a mildly irritating disease.

Causes Of Ocular Rosacea

The exact cause of ocular rosacea, like rosacea, is unknown. This may affect people due to one or more factors, including:

  • Bacteria
  • Environmental factors
  • Eyelash mites
  • Glands blocked in the eyelids
  • Heredity

A number of factors can worsen rosacea, so they can also worsen ocular rosacea. Some of these factors include:

  • Alcohol
  • Certain drugs, such as corticosteroids
  • Certain spicy foods
  • Cheese
  • Chocolate
  • Emotional issues (stress, anger, shyness)
  • Extreme climatic conditions (wind or temperature)
  • Hot drinks or drinks containing caffeine (soft drinks, coffee)
  • Intense physical activity

Ocular Rosacea Symptoms

The symptoms of ocular rosacea may precede those of rosacea, occur simultaneously, or only later. The symptoms of ocular rosacea include:

  • A foreign particle sensation in your eyes
  • Blurred vision
  • Crusts on the eyelids or eyelashes
  • Dilation of small blood vessels on the white part of the eye
  • Dry, red eyes
  • Red and swollen eyelids
  • Sensitivity to light
  • Tingling in the eyes(4)

Usual Treatment Approaches

To relieve ocular rosacea, the doctor prescribes oral antibiotics (cyclins) and possibly eye drops (tetracycline). If you have this form of rosacea, specific hygiene care must also be carried out every evening:

  • Soak a cotton pad in lukewarm water and apply it on your eyelids for ten minutes
  • Massage from bottom to top on the upper eyelids and from top to bottom on the lower eyelids
  • Rinse your eyes with physiological saline in single doses (sterile)
  • Use artificial tears without a preservative if you suffer from dry eyes(5)

References:

  1. Al Arfaj K, Al Zamil W. Spontaneous corneal perforation in ocular rosacea. Middle East African journal of ophthalmology. 2010;17(2):186.
  2. Egeberg A, Hansen PR, Gislason GH, Thyssen JP. Clustering of autoimmune diseases in patients with rosacea. Journal of the American Academy of Dermatology. 2016;74(4):667-672. e661.
  3. Subashini K, Pushpa G, Venugopal V, Murali N. Rosacea with severe ophthalmic involvement and blindness–a rare occurrence. International journal of dermatology. 2012;51(10):1271-1273.
  4. Oltz M, Check J. Rosacea and its ocular manifestations. Optometry-Journal of the American Optometric Association. 2011;82(2):92-103.
  5. Alikhan A, Kurek L, Feldman SR. The role of tetracyclines in rosacea. American journal of clinical dermatology. 2010;11(2):79-87.

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