What Are The Causes Of Ocular Rosacea?

Ocular rosacea is closely linked to the rosacea that commonly affects the skin on the face and sometimes on the back. In particular, ocular rosacea affects the eyelids and may manifest as conjunctival hyperaemia, blepharitis or rosacea associated keratitis.

Causes of Ocular Rosacea

Genetics and environmental factors

The real cause of ocular rosacea is still largely unknown. However, some research suggests that genes and factors such as prolonged exposure to the sun may precipitate the onset of this condition.Other factors that have been linked to ocular rosacea include microorganisms found on the skin’s surface and demodex mites, which commonly inhabit eyelash follicles and may cause in inflammation of the eye.


Given that the symptoms of ocular rosacea ease with antibiotics, there is a possibility that bacteria contribute to this condition when bacterial lipases produce toxic glycerides and the meibominan glands release free fatty acids. Other theories posit that cytokine interleukin 1-alpha, an agent that triggers inflammation increase the amount of metallomatrix protein-9 in the tear fluid, which in turn destroys ocular tissues.

When the meibomian glands are obstructed, the tear film’s structure changes and this could cause instability of the film, reduction of the film’s lipid layer and tear hyperosmolarity.


There is limited research showing the number of people who have been diagnosed with ocular rosacea even though eye-related rosacea is not an unusual occurrence. Even then, some statistics show that generally, rosacea occurs more frequently in women, but when men suffer from rosacea, it is usually severe.


Acne rosacea may also predispose an individual to ocular rosacea. Studies show that up to 18 percent of those diagnosed with acne rosacea also manifests symptoms of ocular rosacea. Other studies claim that ocular rosacea is actually very common affecting as many as 60 percent of those with rosacea.​

How Is Ocular Rosacea Diagnosed?

Diagnosis of ocular rosacea is particularly difficult given the elusiveness of the symptoms. However, the occurrence of cutaneous rosacea accompanied by eye disease is often a solid symptom of ocular rosacea. Other conditions closely related to rosacea and which may be used to diagnose ocular rosacea include blepharitis, periorificial dermatitis and seborrhoeic dermatitis.

Treatments for Ocular Rosacea

Treating ocular rosacea requires the same commitment needed to treat the common rosacea that affects the face. Treatment regimens may take a long time and so patience is required to see significant results.

Eyelid cleansing

Treatment of ocular rosacea primarily involves measures to keep eyelids clean with the daily routine entailing:

  • Use of Q tips to get rid of oily secretion and debris
  • Cleaning eye lids with baby shampoo or simply use plain water

In addition to lid hygiene, doctors usually prescribe a dose of antibiotics or a combination of steroid ointment and antibiotics. Common antibiotics for rosacea include tetracyclines, which help to minimize the thickness of natural oils produced by the eye therefore reducing any blocking of the oil glands that typically accompanies ocular rosacea.

Antibiotics, which are prescribed for long-term use, are typically only taken once or twice daily and most, including doxycycline, can still be absorbed in the body when taken with milk and other foods.

Eye drops

Eye drops can be used to treat dry eye syndrome, which is a common symptom of ocular rosacea. Non-preserved eye drops are prescribed to be used at least four times a day for best results.

Duct plugs

Tear duct plugs may be used to block the drainage duct and may be removed at any time. A permanent solution involves punctual cautery, which entails burning the openings of the tear duct.

Topical medication

Topical metronidazole, which works as an anti-parasitic treatment works effectively to eliminate dermatitis related to rosacea. In spite of its efficacious anti-inflammatory effects, this medicine should not be applied to the eyelids.


Research is still ongoing to find the actual cause(s) of ocular rosacea. While a combination of treatment methods may help to relieve rosacea symptoms, doctors strongly recommend identifying and eliminating triggers that cause inflammation and flare-ups.

For more Rosacea-related content, please take a look at our recommendations for makeup for Rosacea, the best lotion for Rosacea or our review of the best supplements for Rosacea.