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Ocular Rosacea - Subtype 4
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Ocular problems occur in at least 50 percent of patients with rosacea. source
There may be a clinical diagnositic test now available for ocular rosacea. source • another source
One report says, "researchers discovered that the presence of high levels of oligosaccharides in human tears may be a diagnostic indication of ocular rosacea, and that high levels of 13 particular types of the compound were associated with rosacea and may serve as more specific markers for the disorder. Since a general increase of oligosaccharides may not necessarily be specific to rosacea, they emphasized that the types of oligosaccharides found in greatest abundance in rosacea patients should be evaluated in further research for their specificity as markers for ocular rosacea." source
Here is a quote from an article, "Occular Rosacea," by J Bradley Randleman, MD, and C Diane Song, MD, which in part says,
"...rosacea may be thought of as a disease spectrum with 2 primary etiologic components, vascular and inflammatory. The earliest manifestations of the disease are cutaneous vascular dilatory changes with subsequent increased blood flow in the form of telangiectasias and erythema...
The later stages of rosacea are marked by inflammatory changes in the form of papules and pustules in the midface, rhinophyma (bullous nose), blepharitis and meibomitis, and corneal vascularization. A type 4, cell-mediated hypersensitivity reaction has been hypothesized as a possible mechanism. Demodex mites also have been implicated as a possible inflammatory stimulus. Additionally, Helicobacter pylori has been postulated to be a causative factor in a subset of patients. Whatever the underlying mechanism, there is a fundamental abnormality in the sebaceous glands of the face and eyelids, which leads to the inflammatory changes exhibited....In the US: More than 10% of the general population exhibits dermatologic characteristics of rosacea..."
source > http://www.emedicine.com/OPH/topic115.htm
There are some photos of advanced ocular rosacea, Subtype 4, at the bottom of the above article. It is bizzare to me that anyone would wait that long to go to a dermatologist for help when as the article so clearly states at the bottom, "Failure to recognize, diagnose, and treat rosacea can compromise the integrity of the ocular surface." It also says that "Additionally, ophthalmologists probably underdiagnose rosacea due to a lack of familiarity with the dermatologic manifestations of the disease."
When it comes to occular rosacea here are my suggestions:
Read Dr. Latkany's book, The Dry Eye Remedy:
(1) Tea Tree Oil • OcuSoft Products 
(2) Read Dr. Nase's book
(3) Read Dr. Nase's comment on occular rosacea. Read The New Age of Ocular Treatments
(4) Try the Rosacea Diet for thirty days
(5) Carbomer gel that contains superoxide dismutase
(6) Cutting Edge Eye Drops
(7) Vitamin A, Vitamin C, & Gluthathione > source
(8) Eye make up suggestions > source
(9) rosaceagroup.org occular page
(10) Four new eye drops
(11) Cyclosporine drops
(12) Laser Eye Correction Specialists
(13) Pilocarpine gel
(14) Isoptocarbachol 3% eyedrops
(15) Alice Haddow's Advice
(16) American Academy of Family Physicians suggested treatment:
"Oral tetracycline and doxycycline effectively control the ocular symptoms of rosacea; these are the only agents that have been rigorously studied in the treatment of ocular rosacea2,15 [Evidence level B, nonrandomized studies]. A short course of topical corticosteroid solution may be useful for symptomatic relief of ocular rosacea2; however, ocular steroid therapy should be initiated and managed by an ophthalmologist because experience with this treatment is limited. Liquid tears are useful for dry eyes and relief of ocular itching.2 Low-dose treatment with oral isotretinoin (10 mg, three times weekly for two to three months) has also been successful in recalcitrant ocular cases2 [Evidence level C, expert opinion]." source
"...We surveyed retrospectively the different ocular parasitosis and mycosis diagnosed in our laboratory (Sfax hospital) over a 4 year-period (1996-1999)...Parasitic agents were dominated by Demodex folliculorum (32 cases)..." source
17. Anecdotal Report of a cure for blefaritis and rosacea.
Ronald Boender reports an anecdotal report of a cure for rosacea by "washing my eyelids with Johnson's baby shampoo twice a day with very hot washcloths" and has "been cured for 6 years now and threw away my tetracycline." Ronald says he "read about Demodex folliculorum on the web and realized this was probably my cause of rosacea." source
Demodicosis of ophthalmic concern.
(18) Ocular Rosacea: Dr. Eric Jones, MD
(19) Ocular Rosacea: Dr. Mark J. Mannis, MD
(20) treating ocular rosacea (from the AAO)
(21) Reply to Mona
(22) Scott's 'cure' • More Scott
(23) Restasis
(24) Lisa's long post
More to come, so come back soon for new updates to this page...
If you have a suggestion for this page please email the webmaster
Angiogenesis and Ocular Rosacea
In vitro and in vivo killing of ocular Demodex by tea tree oil.
Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC. MD, PhD, Ocular Surface Center, 7000 SW 97 Avenue, Suite 213, Miami, FL 33173, USA. stseng@ocularsurface.com.
AIMS: To compare the in vitro killing effect of different agents on Demodex and to report the in vivo killing effect of tea tree oil (TTO) on ocular Demodex. METHODS: Survival time of Demodex was measured under the microscope. Sampling and counting of Demodex was performed by a modified method. RESULTS: Demodex folliculorum survived for more than 150 minutes in 10% povidone-iodine, 75% alcohol, 50% baby shampoo, and 4% pilocarpine. However, the survival time was significantly shortened to within 15 minutes in 100% alcohol, 100% TTO, 100% caraway oil, or 100% dill weed oil. TTO's in vitro killing effect was dose dependent. Lid scrub with 50% TTO, but not with 50% baby shampoo, can further stimulate Demodex to move out to the skin. The Demodex count did not reach zero in any of the seven patients receiving daily lid scrub with baby shampoo for 40-350 days. In contrast, the Demodex count dropped to zero in seven of nine patients receiving TTO scrub in 4 weeks without recurrence. CONCLUSIONS: Demodex is resistant to a wide range of antiseptic solutions. Weekly lid scrub with 50% TTO and daily lid scrub with tea tree shampoo is effective in eradicating ocular Demodex. source
Sources
Rosacea: A Common, Yet Commonly Overlooked, Condition
B. WAYNE BLOUNT, M.D., M.P.H., and ALLEN L. PELLETIER, M.D.
University of Tennessee Health Science Center, Memphis, Tennessee
Glycomics Analyses of Tear Fluid for the Diagnostic Detection of Ocular Rosacea
Hyun Joo An, Milady Ninonuevo, Jennifer Aguilan, Hao Liu, Carlito B. Lebrilla,* Lenio S. Alvarenga, and Mark J. Mannis*
Department of Chemistry, Department of Biochemistry and Molecular Medicine, University of California, Davis, California 95616, Division of Biostatistics, MS1C, Department of Public Health Sciences, University of California, Davis, California 95616, Department of Ophthalmology, Federal University of Sao Paulo, UNIFESP, Brazil, and Department of Ophthalmology, University of California, Davis, California 95616
Received June 2, 2005
Association of rosacea and keratoconjunctivitis sicca
M. A. Lemp, M. A. Mahmood and H. H. Weiler
Archives of Opthalmology, Vol. 102 No. 4, April 1984
Acne rosacea with keratitis in childhood
S. A. Erzurum, R. S. Feder and M. J. Greenwald
Division of Pediatric Ophthalmology, Children's Memorial Hospital, Chicago, Ill., Archives of Opthalmology, Vol. 111 No. 2, February 1993
ocular rosacea treatment and pathogenesis
ocular rosacea, MMP8 and doryx
