Rosacea and the effects on the eye.

Rosacea is a chronic, sensitive skin condition often involving inflammation of the cheeks, nose, chin, forehead, and eyes. Rosacea sufferers may experience skin and lid sensitivities, keratitis, chronic infections, and recurrent hordeola. Other signs include excessive flushing, persistent redness, broken capillaries, facial papules, breakouts and rhinophyma typically exacerbated by the environment, medications, diet, stress, and inappropriate hygiene/skincare management.

Are we doing enough to manage?

We routinely see patients suffering from Rosacea in practice, but are we offering a comprehensive approach to treatment and management? What kind of discussions are you having with your patients? Do you wait for them to bring up their concerns or do you feel comfortable initiating the discussion? What is your recommended treatment? Does it vary depending on presentation/symptoms? Do you only treat the eyes or the entire face?

Because Rosacea is a common inflammatory condition which presents in varying degrees, the idea is to manage the underlying cause and then the offending symptoms. Whether Rosacea affects the eyes, the skin around the face or both, being comfortable and aggressive in treating it can be life-changing for many, both from functional and emotional aspects.

The assessment starts outside of the slit lamp, as we look at the overall patient. Some of the prominent signs may be difficult to ignore, especially those that are aesthetically apparent. Some patients have no physical signs on their skin, ever or at the time of the exam, so we consider all of the pertinent ocular health complaints or past history of recurrent ocular health issues of the anterior segment.

Understanding Rosacea is essential.

Having a deep understanding of Rosacea and its many presentations should set the stage for a discussion of findings. Educate, educate, educate – don’t be shy! Having the conversation alone may not be enough, send the patient home with educational materials – easy to read pamphlets, proposed treatment protocols followed in your office, pricing, etc. Give the patients a chance to digest what they are in for. Explore if the patient is being co-managed by a dermatologist and what is the treatment at hand – efficacy, compliance, follow-up, etc.

When it comes to managing the ocular surface, it may be as easy as some over the counter treatments to address dryness and lid hygiene. In more severe cases, management may be as involved as lid scrubs, tear stabilizing agents, oral meds and in-office treatments promoting meibum flow. And in other cases, a combination of some of the above, as well as at-home skincare routine promoting hydration and strengthening of the skin’s natural moisture barrier along with in-office facial treatment, such as a series of gentle chemical peels, may be indicated.

Explore potential skincare lines; ask colleagues which lines they work with and why.

Selecting a line that is effective, simple, supportive of the healthcare professional and is easy to work with is key. Consider getting trained or having a staff member trained in chemical peels, so that they can administer the treatments; some lines offer complimentary training sessions by licensed professionals on individual products and in-office treatments.

Know key active ingredient. Do not hesitate to take “before and after” images, and share the progress with each patient. Stress the chronic nature of the condition and compliance for positive, visible results. Do not be hesitant to refer for more invasive treatments which you may not be able to perform in your setting, including lasers.

Think outside the box. Managing a unique condition, typically punted off to a “specialist,” is another way to differentiate yourself, manage your patients more effectively, build loyalty, and support the financial growth of your practice.