Rosacea: The Eyes Have It, Too

JORDAN PYSZ / iFoundMyDoctor.com
Cathy has finally found relief from her lifelong battle with dry eye disease. She can now enjoy her free time, which includes quilting, working in the yard, volunteering and getting together with friends. She’s also involved with renovations to her house.

Cathy Vrh took the first of her many jobs as soon as she became old enough to legally do so, while in high school, with a New York department store.

Decades later, in 2019, she retired and moved to Florida.

“I’ve held numerous positions over the years, mostly retail and office work, and I’ve worked in several different businesses,” Cathy elaborates. “My favorite job was doing office work in the staffing industry. We worked to find business jobs for people.”

In 2019, after living in Michigan for 41 years, Cathy and her husband chose to retire in Florida.

“It gets cold up in Michigan,” she states. “My husband and I just wanted to move someplace warmer, to get out of the cold weather. We’re permanent Florida residents now, and we like it here.”

When she has time, Cathy quilts, works in the yard, volunteers and socializes with friends. She and her husband are currently renovating their home, which she also enjoys.

One thing Cathy has not enjoyed is her long-running battle with dry eye disease, a common disorder that develops when the tears can’t provide sufficient lubrication to keep the eyes moist.

Dry eye affects the tear film, which includes layers of oil, water and mucus that protect the surface of the eyes.

Cathy has dealt with the issue for most of her life and suffered from a variety of its irritating symptoms.

“My eyes were dry and itchy, and my vision was blurry,” Cathy discloses. “My eyes caused me a great deal of discomfort every day. And when I woke up at night, I could hardly open my eyes because they were so dry.”

In an effort to alleviate those symptoms and moisten her eyes, Cathy used artificial tears multiple times each day. But her eyes remained dry and uncomfortable. In 2022, she finally saw a light at the end of the tunnel.

“One day, I got a postcard in the mail from Dry Eye Center of Florida,” Cathy remembers. “I called immediately and got an appointment with Dr. Ramsower, and I’m really glad I did.”

Combination Dry Eye

Jenifer Ramsower, OD, is the founder of Dry Eye Center of Florida, a practice dedicated to the diagnosis and treatment of dry eye disease.

Dr. Ramsower began her treatment by ordering a blood test that showed Cathy suffers from Sjögren’s syndrome, an autoimmune disease in which the immune system attacks the glands that produce tears. The symptoms can be discomfort, weakened vision, and dry eyes and mouth.

“Dr. Ramsower also told me that I have ocular rosacea,” Cathy recalls. “I’ve had rosacea on my face for a while, and I guess it spread to my eyes. It caused severe irritation, blurry vision and pain.”

Rosacea is a chronic condition that causes redness and visible blood vessels in the face. The origin is unknown, but it is believed to involve genetic and environmental factors, as well as abnormalities in facial blood vessels.

“Rosacea leads to inflammation of the skin of the face, causing it to appear flushed or rosy, and the eyelids are an extension of that skin,” Dr. Ramsower informs. “Inflammation of the facial skin can lead to inflammation around the eyelid margin, where the meibomian – or oil – glands are located. Rosacea found inside the lid margin is called ocular rosacea.
-Dr. Ramsower

“The inflammation from ocular rosacea can clog the meibomian glands and inhibit the flow of oil into the tear film. This causes meibomian gland dysfunction (MGD). MGD causes the tears to evaporate quickly and leads to dry eye disease. We must address MGD and ocular rosacea because they can lead to a loss of gland structure and aggravate the symptoms of dry eye disease.”

Dr. Ramsower’s evaluation revealed that Cathy had a combination-type of dry eye disease, with a deficient oil layer and inadequate tear volume. As a result, her treatment required multiple approaches.

“I started Ms. Vrh on a low-dose of oral doxycycline (an antibiotic) that doesn’t upset the stomach,” the doctor reports. “I also recommended a special skin care regimen aimed at calming the skin and improving the skin barrier, which helps reduce inflammation. We offer a unique skin care line for this purpose. We also employ a licensed aesthetician, who performs facials that help soothe rosacea.”

To further alleviate the symptoms associated with Cathy’s MGD and ocular rosacea, Dr. Ramsower used a combination of FDA-certified advanced treatments. One is the Johnson & Johnson® LipiFlow® Thermal Pulsation System, which helps clear meibomian gland obstructions. The other is the Lumenis® Optima Intense Pulsed Light (IPL), which decreases inflammation.

“In addition, I implanted tiny devices called punctal plugs into Ms. Vrh’s eyes to prevent the outflow of tears from her eyes to increase her tear volume,” Dr. Ramsower notes. “She doesn’t make many tears naturally because of the Sjögren’s. The goals are to boost the volume of tears and rebuild her oil layer.”

“A Great Improvement”

It didn’t take long for Cathy to feel the effects of Dr. Ramsower’s treatment plan.

“I would say that within three months I saw a great improvement in my condition,” she enthuses. “Dr. Ramsower did the LipiFlow to clean out my oil glands, put plugs in my eyes and used the IPL, which cleared up the rosacea.

“She gave me special eyedrops and facial cleansers, and an ointment that I put in my eyes at night that melts as I sleep. That way, I can open my eyes when I wake up at night.”

Cathy was doing great, although she experienced a flareup of dry eye symptoms that she attributes to stress.

“I couldn’t get in to see Dr. Ramsower right away because my husband had surgery, so my condition progressed to where we’re doing the IPL and other treatments again,” Cathy relates. “But I can already see a difference from what she’s done so far. The dryness and itchiness are subsiding.

“I’ve had dry eye problems my whole life, but this is the first time I’ve had good results from treatment. I’d never heard of a dry eye specialist before I met Dr. Ramsower, and she’s wonderful. She has helped me tremendously.”