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Premier Vision Clinic, Dr. Jennifer DenHartog,
Optometric Physician

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Ocular Rosacea

Ocular Rosacea is related to an underlying inflammatory condition, Rosacea, which most commonly affects the face. Rosacea is a chronic disorder often characterized by flare-ups and remissions of facial inflammation. For most, the skin presents with a “ruddy” or pinkish flush on the cheeks and nose.

In more severe cases, it may resemble acne with bumpy skin lesions, pimples, and small tortuous blood vessels visible at the surface of the skin called telangiectasias. These errant blood vessels secrete pro-inflammatory cells which cause further inflammation of the skin. This vicious cycle affects the eyes in up to 60% of patients with Rosacea, although the exact incidence isn’t known.

Who is at Risk?

Rosacea more commonly affects women over the age of 30 who are fair skinned, although men can develop rosacea as well, and tend to have more severe symptoms.

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Symptoms of Ocular Rosacea

Symptoms of ocular rosacea may include:
  • Dry eyes
  • Burning or stinging in the eyes
  • Itchy eyes
  • Grittiness or feeling of having a foreign body in the eye or eyes
  • Blurred vision
  • Sensitivity to light
  • Redness
  • Dilated small blood vessels on the white part of the eye
  • Red, swollen eyelids
  • Tearing

The severity of ocular rosacea symptoms doesn’t always match the severity of skin symptoms.

What may trigger an exacerbation of symptoms?

Rosacea, as well as Ocular Rosacea, often have triggers. These vary from person to person. Avoiding certain triggers may help you manage flare-ups.

  • Sun exposure -Certain foods such as spicy -Alcohol consumption
  • Emotional stress -Hot weather -Cold weather
  • Wind -Heavy exercise -Hot beverages
  • Indoor heat -Certain skin-care products & cosmetics -Hot baths
  • Certain medications & medical conditions

Treatment for Ocular Rosacea

Treatment Options

There is much that is not known about Rosacea and its ocular component. Genetics may be a factor, and there are a few studies which suggest that nutrition and gut health may also play a role, although further studies are needed to make a determination.

As of now, treatment is aimed at controlling the inflammation and treating the meibomian gland dysfunction. Possible treatments may include oral medication, controlling allergies, avoiding triggers, and using eye drops when needed, as well as at home and in office heat treatments to secrete the meibum and provide relief.

Routine eye exams are important, regardless of your age or physical health.

iLux Treatment System

The iLux MGD treatment system treats Dry Eye by using light energy to warm meibomian glands quickly and comfortably.  The treatment can be performed within 10-15 minutes and most patients will feel relief immediately after.

Dr. Jenn’s Opinion:

The iLux Meibomian gland treatment system is very effective in cleaning out the clogged, damaged, or diseased glands.  We use a new disposable tip to treat both eyes for each patient. The procedure does not hurt or feel uncomfortable. The light that heats the device is bright, but your eye is protected by a shield on the tip.  The treatment consists of 3 intervals per eye, each interval lasting approximately 1 minute. What makes this system amazingly effective is that it heats not only from the outside of the lid, but also from the inside.

Short-Term Effects

After having the iLux treatment, most patients feel relief from dry   Some, however, will have a slight increase in symptoms of dryness for a day or 2.  In evaluating all of the hardened oils, we have also depleted the supply in the gland.  Once the oil production is flowing and is in a more “normal” state, symptoms typically improve. This treatment improves the success of the at-home therapies as well.

iLux vs. In-home Therapies

At-home treatments such as heat masks are limited by the fact that you have to go through skin and muscle in order to reach the gland, which makes it difficult to reach the optimal temperature to melt the thick oils in the gland.  In cases of more severe disease, the melting temperature of the oils can be slightly higher, making these treatments less effective.

With iLux, we also heat from  inside  the lid where we are able to gain direct access to the glands, making it more feasible to heat to the desired temperature.  While performing the iLux treatment, I am able to visualize the glands along the lid, and watch as the hardened oil is melted and expressed out of the gland.  

In my opinion, this is extremely valuable, especially in more severe cases where it may take longer to melt the hardened meibum (oil). Once the glands are evacuated, I am able to massage the lid margin with slight pressure and extract any residual meibum before moving on to the next treatment zone.

Long-term Effects

Unfortunately, Meibomian Gland Dysfunction is a chronic, progressive disease, so one treatment does not cure it. Rather, I recommend using the in-office treatment like a “deep cleaning”, similar to having our teeth cleaned at the dentist.  Removing all of the hardened meibum and any hardened or calloused area along the lid margin is not all that different of a concept to removing built-up plaque every 6 months at the dentist.  I have truly found that those patients who are treated regularly, once or twice a year, with an in-office heat treatment, see better results from their treatments at home and have better success in slowing the progression of the disease.

NuLids At-home Treatment

The NuLids System is a highly effective once-a-day at-home treatment device specifically designed to reduce the signs and symptoms associated with blepharitis and Dry Eye. The NuLids System is easy-to-use and only takes one minute to complete for both eyes. The NuLids device is compact and cordless so that you can take it just about anywhere.  

Dr. Jenn’s Opinion: 

For years we recommended using a heat treatment at home to soften the waxy deposits, then using a scrub and a washcloth to try and wash the area clean.  That system was highly ineffective, and for years patients would continue to complain of symptoms of redness, irritation, and itchy or scaly eyelids. Since starting those patients on NuLids, at routine follow-ups, I have noticed that their lids are often perfectly clean. The NuLids treatment takes less time, is more effective, and feels better!  Most importantly, it keeps the condition under control with proper maintenance.

How does the NuLids System work?

The NuLids System treats Blepharitis and Dry Eye disease caused by Meibomian gland dysfunction. NuLids is clinically proven safe and effective for removal of biofilm and scarf that occlude the openings of the Meibomian glands. These glands are responsible for producing the lipid layer of the tear film. In studies, lipid deficiency is the cause of Dry Eye Disease in 86% of all cases. In addition, the gentle massaging action of the NuLids Daily Disposable Tip may stimulate capillary perfusion at the lid margins and contribute to overall better eyelid health.

Short-Term Effects

Patients typically notice a distinct improvement in comfort and a significant reduction in their dry eye symptoms often in the first month of use. When used as directed, many patients report a noticeable improvement in about 8-10 days.  NuLids is an important part of your doctor’s treatment plan, but it is not a cure for the root issue. Continuing with all therapies prescribed by your eye care professional will result in the best treatment outcome.

Additional Info

Many patients who have a lack of meibum, or the outer oily layer in their tear film, often have several underlying causes.  Many have damaged glands, which affects the overall amount of meibum which may be secreted. When the meibum becomes thick, it isn’t secreted well, and over time the gland becomes damaged.  

This can be aided by heat therapy, either in the office or at home, but in order for the heat therapy to work, the glands need to be open at the lid margin. In most cases, I also notice that there is a fine line of keratinization along the lid margin, covering the gland openings.  This line is sort of like a mild “callous” over the mucous membrane on your lid margin. The margin is the area where the epidermis of your skin meets the inner lining of your eyelid. If the biome is disrupted and the inner lining becomes keratinized and calloused, then no matter how much heat we apply, the meibum cannot be expressed and the gland function will not improve.

We always remove the keratinization and clean the lid margin in the office prior to any in-office heat treatments, to ensure the greatest success.  However, in many patients, I have noticed that the effects of their in-office and at-home therapies were diminished as the keratinization returned during their normal daily routines.  Simply using lid scrubs is not enough to slough off the dead skin that gathers in the wrong place.

The lid scrubs do help to control bacteria and are an important part of the overall treatment, but I have found that the mechanical debridement with the NuLids device is most beneficial.  Again, to quote the dental example, using heat and lid scrubs, and wiping your lids is like using your toothbrush with toothpaste every night. Using the NuLids is like using an electric toothbrush – it just works better! And when you visit us for your in-office therapy, it’s like getting a really deep cleaning, preventing further development of this chronically progressive disease.

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