Natural Support for Ocular Rosacea

Ocular Rosacea1 in 10 Adults Get Ocular Rosacea

Ocular rosacea is an inflammation of the white of the eye caused by immune system weakness. It can also affect the cornea and usually develops only in the eyes. It appears in combination with the skin version of rosacea in 20% of facial rosacea patients.

Bird’s Eye View
Ocular rosacea makes the eyes and skin nearby red, itchy, or sore – and it can escalate to harming vision and the cornea.
Risk factors include already having rosacea on other parts of the face, fair skin, light-colored hair and eyes, and age.
Treatment can have side effects; therefore, Natural Eye Care recommends specific lifestyle and food choices to support
Be sure to consult with your doctor, dermatologist, or eye doctor if you have symptoms.

Rosacea is fairly common and is experienced by as many as 10% of adults, especially:

      • People with fair skin and light-colored hair and eyes. More than half of these patients also have ocular rosacea and/or related problems, such as blepharitis and conjunctivitis.1
      • People between ages 30 and 60.
      • Women going through menopause are also vulnerable to ocular rosacea, and experience ocular rosacea twice as often as men.
      • It is underrecognized in children and individuals with darker skin tone.

What is Ocular Rosacea?

The cornea is the lens in front of the eyes that does most of the refracting of light to the retina, and it is covered by a thin opaque layer called the sclera (also referred to as the white of the eyes). Ocular redness caused by ocular rosacea is due to inflammation of the sclera that can extend to, and damage, the cornea.

This condition is caused by inherent defects in the body’s immune system and vessels that carry blood and lymph fluid, particularly arteries and veins. Usually, the condition develops only in the eyes, but sometimes, it is experienced in combination with the skin version of rosacea. Ocular rosacea can also affect the cornea of your eye, especially if you have dry eyes. It affects roughly 20% of facial rosacea patients.

Pathology

Researchers suspect that ocular rosacea derives from a mix of immune system and vascular irregularities and weaknesses.2 Increased eyelid bacteria produce several fatty or waxy substances3 that, in turn, cause increased levels of toxic biochemicals that irritate the cornea and surfaces adjacent to the cornea.4 5

In the healthy eye, oily meibum covers the cornea’s surface, helping to slow the evaporation of tears. However, increased toxic and irritating biochemicals (proinflammatory cytokine and matrix metalloproteinase) cause the meibum to thicken, reducing its ability to protect the tear film.6 In this way, the process of chronic inflammation reinforces itself. Chronic inflammation suppresses meibomian gland function, further reinforcing the development of ocular rosacea, not to mention dry eye syndrome.

Microscopic demodex mite infection also develops. Demodex brevis lives in the meibomian glands. Demodex folliculorum specializes in the area around the eyelids and eyelashes, where it feeds on skin cells and increases the number of skin cells on the surface of the eyelash.7 To further the self-reinforcing cycle of dysfunction, these mites carry bacteria that stimulate enzymes that degrade cellular proteins.8

Forty percent of ocular rosacea patients also develop damage to the outer protective epithelium layer of the cornea. Damage takes the form of pinpoint indentations called punctate epithelial erosions that by themselves cause redness, irritation, and light sensitivity.9

Sign and Symptoms

The following ocular rosacea symptoms10 are most related to, and include, the symptoms of blepharitis, conjunctivitis, and dry eye syndrome.

      • Eye redness of conjunctiva, sclera, and/or eyelids
      • Dry eyes
      • Itching, burning, irritation of eyelids and surface of the eye
      • Blurred vision
      • Sensitivity to light
      • Tearing
      • Recurring instances of blepharitis, conjunctivitis, or dry eye syndrome

Signs that your eye doctor will identify include:11

      • Clogged meibomian glands
      • Growth of new blood vessels in the cornea
      • Capillary leakage, resulting in corneal scarring and loss of transparency

Other conditions can occur along with ocular rosacea, sometimes as an apparent cause or result of the ocular inflammation. These include styes or chalazia, eye infections such as iritis and episcleritis, corneal or scleral ulcers and perforations, and conjunctivitis

Causes and Risk Factors

      • Blocked meibomian glands that lie along the base of the eyelashes
      • Demodex mites along the base of the eyelashes
      • Bacterial involvement
      • Environmental irritants
      • Heredity
      • Hot baths and saunas
      • Strenuous exercise
      • Hot spicy foods
      • Exposure to sunlight and hot weather
      • Medications such as cortisone creams and drugs

Conventional medicine offers no “cure” for ocular rosacea. Doctors may prescribe oral antibiotics, vitamin A derivatives that suppress sebum, immunomodulators that reduce the immune response, corticosteroids to reduce inflammation, artificial tears, and eyelid hygiene protocols.

A Natural Approach

Reduce Overactive Immune Response

As ocular rosacea may be aggravated or caused by an overactive immune response, we suggest addressing the chronic inflammation of ocular rosacea through targeted supplementation, an alkaline diet, overall corneal health, healthy eye lubrication, and paying attention to eyelid health through warm compresses and lid scrubs.

Support Cornea with Nutrients

Glutathione.  This is taken preferably in an intraoral or sublingual form, as glutathione is not absorbed well through the digestive system. Glutathione is a key component of the antioxidant system of the cornea, ciliary body, sclera, and iris of the eye, where it is normally present at high levels.12 GSH levels are noted to be low in lab animals with corneal epithelium wound issues.13 It may be important in preventing more serious corneal damage in ocular rosacea cases.14 In an animal model, eyedrops containing glutathione effectively treated corneal neovascularization.15

Black currant seed oil. For related dry eye symptoms, black currant seed oil helps stimulate tear secretion and reduce inflammation.16

Turmeric (curcumin). Curcumin is generally effective as an anti-inflammatory nutrient. It is recommended for facial rosacea and might be helpful for ocular rosacea.17 In animal models, curcumin has been found in the sclera, and it has been shown to help reduce inflammation.18 It also has been found to reduce matrix metalloproteinases, one of the irritant biochemicals produced in excess by bacteria on the eyelid that causes the meibum to thicken.19

MSM capsules. MSM helps nourish and strengthen body tissues and has natural anti-inflammatory properties. Combined with silymarin, it helps treat skin rosacea20 and may be beneficial for ocular rosacea.

Omega-3 fatty acids. Omega-3s have anti-inflammatory properties. One of the omega-3s, DHA, increases mitochondrial activity and has antioxidative, anti-inflammatory, anti-apoptotic, and anti-angiogenic effects.21 Research shows that it helps protect the corneal epithelium after surgery.22 In rosacea patients with dry eye symptoms, omega-3s in the diet for three to six months improved the condition significantly.23

Consider Diet

Drink plenty of water throughout the day.

Food choices play a key role in controlling all forms of rosacea. The following foods can trigger a rosacea flare-up, possibly contributing to ocular rosacea.24

      • Spicy foods
      • Very hot soups or beverages
      • Broad-leaf beans and pods, including lima, navy, or pea
      • Dairy products like yogurt or sour cream
      • Chocolate
      • Some citrus fruits
      • Foods high in histamine, such as cheese (except cottage cheese), eggplant, spinach, vinegar, and soy sauce

Juicing. Juicing is a good way to deliver nutrients to your body. Take a look at this list of suggested foods for people with rosacea. You can select from any combination of these, plus add your favorite fruits and vegetables.

      • Celery, carrot, leafy-green vegetables, blueberries, cherries, other berries, parsley, watermelon, lemons, bananas, ginger, avocado, coconut, and lemon
      • Try to use room-temperature vegetables and fruit.
      • Do not add ice or very cold liquids since cold foods and liquids will eventually extinguish the stomach’s digestive fire.
      • Do not juice as often during the cooler months of the year; instead, switch to vegetable soups or stews.

Lifestyle

      1. Keep your eyelids clean by gently washing them daily.
      2. Try commercially prepared lid wipes or incorporate a very diluted tea tree oil solution once or twice daily along the eyelid.
      3. Temporarily suspend wearing contact lenses while you have the condition.
      4. Avoid rubbing your eyes.
      5. Use a warm, wet washcloth as a compress, holding it in place until it cools. Repeat this several times a day.
      6. While at your computer, take frequent breaks, and don’t forget to blink.
      7. Use a humidifier at home. Dry eye syndrome is a common problem for those with ocular rosacea. Keeping the air moist at home and regular use of preservative-free eyedrops can help reduce dry eye symptoms and possibly avoid further complications due to chronic dry eyes.
      8. Ensure your eye makeup is non-toxic, non-irritating, and preferably organic. Remove all makeup at night.
      9. Wear 100% UVA/UVB-protecting sunglasses outdoors. Ideally, use wrap-around sunglasses with either amber or brown lenses.

Suggested Supplements/Eyedrops

Ortho K Thin (Daytime) Homeopathic Eye Drops 10ml per bottle

Ortho K Thick (Nighttime) Homeopathic Eyedrops 10ml per bottle

ACG Glutathione EXTRA STRENGTH Spray 2oz

MSM Drops 1 oz (4% solution)

OmegaGenics™ EPA-DHA 720 Lemon 120 gels

Dr. Grossman’s Premium Turmeric Vcaps (Organic)

Packages

Rosacea Package 1

Rosacea Package 1A

Footnotes

  1. Weidmayer, S. (2015). Seeing Red: How Ocular Rosacea Impacts the Cornea. Retrieved Apr 30 2018 from https://www.reviewofoptometry.com/article/seeing-red-how-ocular-rosacea-impacts-the-cornea.
  2. Donaldson, K.E., Karp, C.L., Dunbar, M.T. (2007). Evaluation and treatment of children with ocular rosacea. Cornea, 26(1):42-6.
  3. Ta, C.N., Shine, W.E., McCulley, J.P., et al. (2003). Effects of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis. Cornea, 22(6):545-8.
  4. Dougherty, J.M., McCulley, J.P. (1986). Bacterial Lipases and Chronic Blepharitis. Invest Ophthalmol Vis Sci, 27(4):486-91.
  5. Redd TK, Seitzman GD. Ocular rosacea. Curr Opin Ophthalmol. 2020 Nov;31(6):503-507.
  6. Onaran, Z., Karabulut, A.A., Usta, G., Örnek, K. (2012). Central corneal thickness in patients with mild to moderate rosacea. Can J Ophthalmol, 47(6):504-8.
  7. Leonard, J. (2017). What is Demodox brevis? Med News Today. Retrieved Apr 30 2018 from https://www.medicalnewstoday.com/articles/320159.php.
  8. Wikipedia. Matrix metalloproteinase. Retrieved Apr 30 2018 from https://en.wikipedia.org/wiki/Matrix_metalloproteinase.
  9. Wikipedia. Punctate opithelial erosions. Retrieved Apr 30 2018 from https://en.wikipedia.org/wiki/Punctate_epithelial_erosions.
  10. Tavassoli S, Wong N, Chan E. Ocular manifestations of rosacea: A clinical review. Clin Exp Ophthalmol. 2021 Mar;49(2):104-117.
  11. Ibid. Tavassoli. (2021).
  12. Kolin, C., Reichi, S. (2016). Expression of glutathione transferases in corneal cell lines, corneal tissues and a human cornea construct. Int J Pharm, Jun 15;506(1-2):371-81.
  13. Zhang, Z., Hu, X., Qi, X., Di, G., Zhang, Y., et al. (2018). Resolvin D1 promotes corneal epithelial wound healing and restoration of mechanical sensation in diabetic mice. Mol Vis, Apr 1;24:274-285.
  14. Yogananarajah, V., Li, B., Umapathy, A., Donaldson, P.J., Lim, J.C. (2017). Regional differences in glutathione accumulation pathways in the rat cornea: Mapping of amino acid transporters involved in glutathione synthesis. Exp Eye Res, Aug;161:89-100.
  15. Oquido, A.P.M.T., Hohmann, M.S.N., Pinho-Ribeiro, F.A., Crespigio, J., Domiciano, T.P., et al. (2017). Naringenin Eye Drops Inhibit Corneal Neovascularization by Anti-Inflammatory and Antioxidant Mechanisms. Invest Ophthalmol Vis Sci, Nov 1;58(13):5764-5776.
  16. Baudouin C. (2001). Dry eye: an unexpected inflammatory disease. Arch Soc Esp Oftalmol, Apr;76(4):205-6.
  17. Barbalho SM, de Sousa Gonzaga HF, de Souza GA, de Alvares Goulart R, de Sousa Gonzaga ML, de Alvarez Rezende B. Dermatological effects of Curcuma species: a systematic review. Clin Exp Dermatol. 2021 Jul;46(5):825-833.
  18. Zhang, J., Zhou, N., Zhang, B., Ma, J. (2018). Effect of Biodegradable Scleral Plugs Containing Curcumin on Proliferative Vitreoretinopathy. Ophthalmic Res, 59(1):30-36.
  19. Zhang, Y., Gu, Y., Lee, H.M., Hambardjieva, E., Vrankova, K., et al. (2012). Design, synthesis and biological activity of new polyenolic inhibitors of matrix metalloproteinases: a focus on chemically-modified curcumins. Curr Med Chem, 19(25):4348-58.
  20. Berardesca, E., Cameli, N., Cavollotti, C, Levy, J.L., Pierard, G.E., et al. (2008). Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation. J Cosmet Dermatol, Mar;7(1):8-14.
  21. SanGiovanni, J.P., Chew, E.Y. (2005). The role of omega-3 long-chain polyunsaturated fatty acids in health and disease of the retina. Prog Retin Eye Res, 24(1): 87-138.
  22. Kenchegowda, S., He, J., Bazan, H.E. (2013). Involvement of pigment epithelium-derived factor, docosahexaenoic acid and neuroprotectin D1 in corneal inflammation and nerve integrity after refractive surgery. Prostaglandins Leukot Essent Fatty Acids, Jan;88)1):27-31.
  23. Bhargava, R., Chandra, M., Bansal, U., Singh, D., Ranjan, S., et al. (2016). A Randomized Controlled Trial of Omega 3 Fatty Acids in Rosacea Patients with Dry Eye Symptoms. Curr Eye Res, Oct;41(10):1274-1280.
  24. Everyday Health. Are Diet and Alternative Treatments Effective for Rosacea? Retrieved Apr 30 2018 from https://www.everydayhealth.com/rosacea/experts-are-diet-and-alternative-treatments-effective.aspx.