Rosacea Awareness Month

Rosacea affects the eyes in many patients, and may result in a watery or bloodshot appearance, irritation and burning or stinging. The eyelids may also become swollen, and styes are common.

April has been designated as Rosacea Awareness Month with the intent to educate the public on the warning signs of this chronic but treatable facial disorder. Rosacea is a common but poorly understood disorder of the facial skin that is estimated to affect well over 16 million Americans — and most of them don’t know it. In fact, while rosacea is becoming increasingly widespread as the populous baby boom generation enters the most susceptible ages, a National Rosacea Society survey found that 95 percent of rosacea patients had known little or nothing about its signs and symptoms prior to their diagnosis.

Photo from National Rosacea Society
Photo from National Rosacea Society

Rosacea typically presents anytime after the age of 30 and may initially resemble a simple sunburn or an inexplicable blush. Suddenly, without warning, a flush comes to the cheeks, nose, chin or forehead. This recurs over and over with the redness lasting longer each time and eventually visible blood vessels may appear. Without treatment, bumps and pimples often develop, growing more extensive over time and burning and itching are common.

In severe cases, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose. The eyes can be affected too. Ocular involvement includes watery, burning and bloodshot eyes.

Ongoing research has suggested that rosacea may be caused by various possible factors, including defects of the immune system, nervous system, facial blood vessels and genetics. Most recently the presence of microbes and Demodex mites on the skin can trigger symptoms. Demodex are normal inhabitants of human skin but occur in far greater numbers in people with rosacea. It is believed that an immune response to bacteria associated with the mites may lead to the inflammatory bumps and pimples.

A study by a dermatologist at Duke University found a significant association between the relative presence of the mites and the development of rosacea, suggestion that the microscopic mites may be involved in the disease process. The study authors also proposed that increased mite density in the skin might trigger inflammatory response, block hair follicles or help transmit other bacteria in the skin , leading to signs and symptoms of rosacea.

Demodex mites also live in the eyelash follicles. they survive on dead skin and protein. We have found that reducing the number of Demodex living on the eyelid can reduce dry eye symptoms of burning and waterness. Controlling the Demodex requires a special cleaning solution containing a derivative of Tee Tree Oil. If you have or suspect you have rosacea and are suffering from burning red eyes, make an appointment in our dry eye clinic for evaluation and treatment.

Although the definitive cause of rosacea remains unknown, a vast array of lifestyle and environmental factors have been found to trigger flare-ups of signs and symptoms in various individuals. Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, certain skin-care products and potentially an overabundance of Demodex mites.

Signs and Symptoms of Rosacea

  • Redness on the cheeks, nose , chin or forehead
  • Small visible blood vessels on the face
  • Bumps or pimples on the face
  • Watery or irritated eyes

Allergic Conjunctivitis

Allergies are widespread, affecting 30% or more of the U.S. population. Allergic conjunctivitis and rhinitis (runny nose) can exact a significant toll on individuals. The most common Allergiessymptom of eye allergies is itching, which can range from mildly uncomfortable to severely bothersome. Itching and other symptoms which include watery eyes, redness, pain, soreness, stinging and swelling, may reduce a persons ability to perform daily routines or activities at school or work.

There are two common forms of ocular allergy,  seasonal and perennial. Of the two, seasonal allergies are the more common. Seasonal allergies are triggered by seasonal items such as tree, grass and weed pollens that abound in spring and fall. People sensitive to these allergens tend to have symptoms most frequently during those seasons. When the allergies are no longer present, a seasonal allergy sufferer doesn’t have symptoms.
Perennial allergies, by contrast, are triggered by environmental allergens commonly found in the home – such as dust mites, mold spores or animal dander – and do not follow a seasonal distributions. As a result, if you have perennial allergies, you suffer all year long.

Treatment
Avoidance of the allergen or cause of the allergy is the most successful, but unfortunately isn’t always possible. Minimizing contact can still reduce symptoms however. Many people have found relieve with air filters that remove airborne allergens from the home or office. Dust mites or animal dander control measures can help. Keeping the house and car windows closed will minimize allergens. Simply wearing sunglasses as a mechanical barrier and washing hair in the evening can help reduce allergen exposure.

If your symptoms are minimal or intermittent, applying a cold compress (10-15 minutes) may relieve symptoms, especially itching. Artificial tears can bolster ocular defenses by flushing out antigens and can relieve mild ocular allergy symptoms. Benefits of these measures include simplicity, minimal expense and no side effects.

Histamine is central to the allergic reaction and symptoms. Antihistamines are intended to block the effects of histamine. Oral antihistamines can relief systemic symptoms, but may have side effects of sleepiness, dry mouth, and dry eyes. Topical antihistamines target the eye allergy and have less side effects.

Some allergy eye drops combine the antihistamine with mast cell inhibitors. The mast cell inhibitors inhibit the release of histamine and prevent the allergic reaction from starting. I recommend starting this drop at the first sign of symptoms.

For severe eye allergies, a steroid eye drop may be necessary to interrupt the allergic cycle. Steroid eye drops are very effective but have many potential side effects and must be used only as prescribed.

Don’t suffer from allergies. Discuss your symptoms and concerns with Dr. Griffith or Dr. Staton.

 

Wintertime Dry Eyes

Winter winds and moisture zapping heaters can cause dry, red and irritated eyes.
Tears are essential for good eye health and clear vision. They bathe the eye, washing out dust and debris, and keep the surface moist and clear. The natural tear film also contains enzymes that neutralize microorganisms, reducing the risk of eye infections.
The most common signs and symptoms of dry eyes are persistent dryness and irritation, scratchiness, a burning feeling in your eyes and red eyes. Oddly enough, dry eye syndrome also can make your eyes watery, as dryness can cause a protective overproduction of the watery component of your tears.

How to prevent dry eyes in winter

Cold winter wind outdoors and dry heat indoors can cause or worsen dry eyes. Follow these tips to keep dry eyes at bay.

  • Wear sunglasses or goggles. Wearing close-fitting sunglasses outdoors reduces exposure to sun and wind that can dry out your eyes. If it’s especially cold and windy, try foam-lined goggles that provide even greater protection from tear evaporation.
  • Supplement your diet. Fish oil and other nutritional supplements containing omega-3 fatty acids can help prevent or relieve dry eye symptoms.
  • Drink more water. Mild dehydration often makes dry eyes worse, especially during dry and windy weather.
  • Switch contact lenses. If your contact lenses feel dry and uncomfortable, ask me about trying different lenses that are replaced more frequently and/or are better for someone with dry eyes.

Dry eyes may not be completely curable in certain cases, but the unpleasant dryness, scratchiness and burning sensation can be managed. We are carrying a new artificial tear called Oasis that contains long-molecule hyaluronic acid which keeps the moisture on the eye longer. Click here to read more about dry eye syndrome.

Burning Eyes

Red rimmed eyes, burning eyes, watery eyes. These are symptoms of eyelid inflammation caused from Meibomian gland dysfunction (MGD), blepharitis or both. Another condition of the eyelid that causes discomfort and redness are styes; when one of the eyelid glands becomes infected. Styes are more localized and found on the edge if the eyelid.
The Meibomian glands are between the eyelashes. They can become plugged and inflamed causing problems with the tear quality. The compromised tears evaporate quickly causing the lacrimal gland to overcompensate and produce too many tears which spill over the eyelids. The inflammation produces a foamy discharge that sits on the lower eyelid margin causing irritation and burning.


Blepharitis in an infection or irritation of the eyelid. The typical sign of “bleph” is flakes and/or debris on the eyelashes. The flakes and debris end up in the eye causing irritation and redness.
At night when we sleep, the eye is closed and not blinking. Tear production is greatly reduced. Anything left on the eyelashes and eyelids will sit on the eye all night causing discomfort, grittiness and redness by morning. Treatment involves removing the potential irritants. This includes thorough removal of make-up and creams. A hot compress will soften the waxy plugs in the meibomian glands. Mild cleaning solution and a washcloth or cotton swab will remove debris from the eyelids and eyelashes. For a printable description of eyelid hygiene click here.

Good lid hygeine will improve contact lens comfort during the day, and reduce dry eye symptoms too.

Eye Allergies


Driving through the Sonoma wine country last weekend, I thought how lucky I am to live in such a beautiful place. The fields were green, the lambs were frolicking and the mustard was in full bloom. Gorgeous! But if you suffer from allergies, Sonoma County can be wicked to your eyes and sinuses. Petaluma tends to be particularly windy, stirring up the pollen even more.

Eye allergies are also called “allergic conjunctivitis.” It is a reaction to indoor and outdoor allergens (such as pollen, mold, dust mites or pet dander) that get into your eyes and cause inflammation of the conjunctiva, the white tissue that lines the inside of the eyelid and eyeball. Eye allergies are not contagious.

Other substances called “irritants” (such as dirt, smoke, chlorine, etc.) and even viruses and bacteria, can compound the effect of eye allergies, or even cause irritating symptoms similar to eye allergies for people who are not even allergic. The eyes are an easy target for allergens and irritants because like the skin , they are exposed and sensitive. Dry eyes tend to be more susceptible to ocular allergies because there are less tears to rinse allergens and irritants away.

Certain medications and cosmetics can also cause eye allergy symptoms. By way of response to these allergens and irritants, the body releases chemicals called histamines, which in turn causes inflammation. This reaction makes the eye tissues red and swollen.

The signs of eye allergies are red, itchy, burning, tearing, swollen eyes, along with a gritty sensation. These symptoms may be accompanied by a runny or itchy nose, sneezing, coughing, or a sinus headache. Many sufferers also find that their vision is temporarily blurred.

I find it best to treat eye allergies before the onset of symptoms, but treatment can improve comfort and the appearance of the eye anytime. Do not suffer, there are treatments to control eye allergies.

Eye Allergies

Spring is in the Air
And so is the pollen

75% of allergy symptoms involve the eye. These symptoms include itching, watering and redness. In moderate to severe cases, contact lenses can not be tolerated.

Oral allergy medications can help, but not as quickly or effectively as an allergy eye drop. There are several allergy drops available, some prescription and some over-the-counter. Some of the drops contain antihistamines, decongestants and/or mast cell stabilizers. Antihistamines provide immediate relieve of itching, the mast cell stabilizers provide long-lasting relief. Decongestants constrict the blood vessels to minimize redness, but offer no reduction in the allergic reaction. None of these drops can be used while wearing contact lenses. I will be happy to assist you in selecting the best pharmaceutical solution to your ocular allergies.

Below are some suggestions to minimize the symptoms of ocular allergies and related discomfort.

Recommendations to Reduce Allergic Reactions
 Avoid exposure to allergens
 Rinse eyes with sterile saline solution.
 Cold compresses – place a couple of ice cubes in a clean washcloth
 Maintain contact lens integrity by replacing and cleaning the lenses as prescribed
 Reduce irritation with proper eyelid and eyelash hygiene
 Control ocular dryness with artificial tear drops, proper hydration and supplements
 Begin allergy drops at the first signs of a reaction
 Wear wraparound sunglasses to shield the eyes