Acne Rosacea can cause dry eyes (“ocular rosacea”) which, in turn, can affect LASIK. Patients with ocular rosacea often can have LASIK if rosacea dry eye is treated before surgery. Acne rosacea is a skin disorder which affects the nose, cheeks,chin and forehead. In this condition, the skin becomes oily, bumpy and red. Small red blood vessels called telangiectasia can become noticable and in advanced cases the nose can appear red and bulbous.
There are four subtypes of acne rosacea. Erymatotelangiectatic rosacea is associated with permanent redness with a tendency to blush and flush easily. Prominent small blood vessels appear on the skin and the skin actually can burn or be irritated. Papulopustular rosacea has an element of permanent redness, but also has red pumps, some of which are filled with pus. Phymatous rosacea has rhinophyma, which is an enlargement of the nose. Finally, about half of rosacea patients also have ocular rosacea. In ocular rosacea, the eyes are irritated and light sensitive, with associated burning and stinging.
The root problem in ocular rosacea is that the oil, or lipid, layer of the tears is of poor quality. The tears on the eyes have the job of coating and protecting the cornea. There are three layers to the tears and each layer must be of proper make up. The inner layer, which contacts the cornea, is called the mucin layer and is made of proteins. The mucin layer is produced by the conjunctiva. The middle layer is the watery layer called the aqueous layer. The top layer is the oil or lipid layer. It is made by glands in the eyelids called meibomian glands. The job of the lipid layer is to float to the top of the tears to prevent evaporation and to improve coating of the surface of the cornea.
In ocular rosacea, there is a problem with the composition of the lipid layer and it does not work properly. Patients with ocular rosacea have dry eyes as their tears are unable to adequately perform their job. Paradoxically, because the eye is dry, the body may try to make more tears to counteract the problem, so ocular rosacea patients may have watery eyes that sill are dry and irritated.
Many patients with ocular ance rosacea still can have successful LASIK or PRK laser vision correction eye surgery. However, careful attention must be given by the surgeon to optimizing the quality of the tears by improving the lipid layer before surgery. Treating dry eye caused by ocular rosacea before surgery is very important to achieve the best possible outcomes from LASIK.
There are several things that can be done to improve the lipid layer of the tears in patients with ocular rosacea. Perhaps our best tool is the off-label use of an antibiotic drop called Azasite. Azsite appears to bind directly to the oil layer and change its boiling point. Essentially, it changes the oil layer from Crisco to olive oil, which is what we want to improve function.
Azasite improve lipid based dry eye by a second mechanism as well. In ocular rosacea, there often is a build up of poor quality, thick oils in the meibomian glands that make the oil. Bacteria love to grow in these glands and eat this thick and gooey oil. The excess bacteria tend to produce enzymes called lipases which break down the thick oil into soap like chemicals which are quite irritating to the already irritated dry eyes seen in ocular rosacea. Azasite drops tend to be absorbed into these glands and the help kill off the bacterial overgrowth of the glands that is contributing to irritation and dryness of the eyes.
Other treatments for ocular rosacea that are aimed at improving tear quality include taking oral omega-3 nutrition supplements before LASIK (including flax seed oil and fish or krill oil), taking oral antibiotics such as minocycline, tetracycline, or doxicycline, hot compresses, and lid scrubs, particularly with tea tree oil. Another promising treatment for meibomian gland problems associated with ocular rosacea is the LipiFlow System. Finally, light based skin therapy for acne rosacea, such as controlled spectrum light therapy or intense pulsed light may be able to help reduce symptoms of ocular rosacea by treating the underlying overall rosacea condition of the skin.
See Also
Meibomian Gland Dysfunction and Tear Film Abnormalities in Rosacea
A discussion of the problems in the lipid layer of the tears produced by the meibomian glands in patients with ocular rosacea.
Researchers Make Advances in Understanding of Ocular Rosacea
National Rosacea Society discussion of ocular rosacea.
The Ocular Surface Before LASIK: Pre-Op Treatment Prevents Post-Op Problems.
The importance of treating dry eye before LASIK is emphasized in this discussion by the American Academy of Ophthalmology on preparing the eye for LASIK laser eye surgery.
Intense Pulsed Light for Treating Dry Eye
Review of Ophthalmology article about the use of intense pulsed light (IPL) for treating dry eye.
Shapiro Laser Aesthetics
Controlled Spectrum Light Therapy and its use in treating acne rosacea.
Ocular Rosacea
All About Vision discussion of Ocular Rosacea.