DEAR DR. GOTT: My questions are regarding my blepharitis/ocular rosacea/dry eyes. Right now my eyes are inflamed and my eyelids are reddish so I am assuming it’s a combination of any or all of the above problems. My ophthalmologist gave me a prescription for ophthamolic steroid eyedrops and they cleared up in a very short time; however, I know that they aren’t for permanent use. I have done a lot of research online regarding ocular rosacea and it seems to me that a longer term low dose of doxycycline would be the answer. Do you have any suggestions or comments?
DEAR READER: Before getting into treatment options, I’ll first give a brief explanation of ocular rosacea and blepharitis.
Ocular rosacea is inflammation of the eye due to rosacea (which affects the skin of the cheeks, nose and chin). It typically occurs with facial symptoms (redness, visible blood vessels, small red bumps, tendency to flush or blush, and a red, bulbous nose) but occasionally can develop on its own.
Symptoms include styes, dry eyes, blurred vision, redness, sensitivity to light, itchy eyes, burning or stinging, red/swollen lids, visibly dilated small blood vessels on the white part, and/or grittiness or a feeling of having a foreign body in the eye.
Blepharitis is inflammation of the eyelid, usually near the lash line. It can be caused by rosacea, malfunctioning oil glands, allergies, bacterial infection, seborrheic dermatitis, certain medications, and/or eyelash mites or lice.
Symptoms include watery eyes, greasy eyelids, misdirected eyelashes, sensitivity to light, itchy eyelids, flaking, swollen/red eyelids, eyelid sticking, more frequent blinking, crusted eyelashes upon waking, red eyes, and/or a gritty, burning sensation.
As you can see, these two conditions share many of the same signs and symptoms. If you have rosacea, either condition could be a result. If you do not, it is more likely that blepharitis is the case. You need to determine the cause before you can determine the treatment. I say this because, blepharitis can often be treated without medication, simply by gently washing the affected area with warm water and a mild soap regularly. For some, artificial tears may help. Resistant cases may require steroid eyedrops, ointments or antibiotics. If the underlying cause is known, treatment is necessary. Another important factor to keep in mind is that blepharitis commonly recurs, despite proper treatment. There is no cure for the condition but it can often be controlled.
Severe cases of ocular rosacea may be treated with oral antibiotics or, rarely, steroid eyedrops. Artificial tears may also be beneficial for some but for others may worsen redness. The goal of treatment is to manage the condition, keeping symptoms to a minimum. Once it develops, it won’t go away and there is no cure but it can be controlled.
Return to your ophthalmologist and explain your concerns. Find out what your actual diagnosis is and ask his or her advice regarding treatment, including medications and steps you can take at home to reduce symptoms.
