How rosacea affects the eye
Rosacea is a chronic inflammatory condition of the skin's blood vessels and sebaceous glands. The eyelids carry both, and the meibomian glands are sebaceous glands. In ocular rosacea the lid margins become red and thickened with visible dilated vessels, the gland secretions turn thick and inflammatory, and the tear film loses its oil layer. The inflamed margin also produces styes and chalazia repeatedly. In a minority, inflammation spreads to the cornea, with new vessels growing in from the edge and, if untreated, scarring and thinning.
Symptoms and signs
Burning, gritty, red eyes that do not respond to drops; swollen, red lid margins; recurrent styes and chalazia; light sensitivity; blurred vision from the unstable tear film; and, on the face, flushing, persistent redness across the cheeks and nose, small bumps and visible vessels. Eye symptoms may come first, and patients are sometimes diagnosed with rosacea by their eye doctor.
Diagnosis
The combination of facial rosacea, or its typical distribution of flushing, with inflamed lid margins, meibomian gland dysfunction and telangiectasia at the lid edge is diagnostic. The cornea is examined for peripheral inflammation and vessels. Meibography shows the state of the glands.
Treatment
- Lid hygiene and warm compresses, as for blepharitis and MGD
- Oral doxycycline or minocycline at low dose for two to three months, used for its anti-inflammatory effect on the glands rather than as an antibiotic
- Intense pulsed light: pulses of light applied to the skin below the eyes close the abnormal vessels feeding the inflammation, and warm the glands; typically a series of four sessions, then maintenance
- Thermal gland treatment and expression for the blocked glands
- Anti-inflammatory drops, cyclosporine or lifitegrast, for the surface, and short steroid courses for flares
- Preservative-free lubricants and omega-3 supplementation
- Treatment of the skin rosacea by a dermatologist, and avoidance of personal triggers such as alcohol, spicy food, heat and sun
Corneal involvement is treated urgently by the cornea specialist, with steroids under supervision to prevent scarring.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is what is affecting your vision is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
