A trail of tears may lead to the first diagnostic test for ocular rosacea, a common and potentially serious condition that may result in reduction of vision if left untreated. In a study of human tears funded by the National Rosacea Society (NRS) and published in Rosacea Review, medical scientists have discovered new clues to identify the eye effects of rosacea, a red-faced, acne-like disorder now estimated to affect 14 million Americans."Ocular rosacea is potentially a vision-threatening condition that may be easily missed," said Dr. Mark Mannis, chairman of ophthalmology at the University of California, Davis and one of the study's investigators. "We are excited that our study may ultimately lead to the first diagnostic test that could alert physicians to eye involvement before it grows more serious."
In an NRS survey of 1,780 rosacea patients reporting ocular symptoms, only 27 percent said they had been diagnosed with the condition, suggesting that ocular rosacea may be substantially underdiagnosed. The eyes may be affected in half of all rosacea patients, and typical symptoms may include a watery or bloodshot appearance, dryness, burning or stinging, and visible blood vessels or redness of the eyelid. Left untreated, ocular rosacea can lead to corneal damage and other complications.
In the new study, samples of tears from 16 ocular rosacea patients and 21 individuals without rosacea were collected by Dr. Mannis and colleagues and were analyzed for the presence of oligosaccharides, a type of carbohydrate that may be found in the mucus component of the tear fluid. Oligosaccharides, especially those found in mucus, are known to be sensitive to the biochemical environment, and therefore could be an indicator of disease states.
The researchers discovered that the presence of high levels of oligosaccharides in human tears may be a diagnostic indication of ocular rosacea, and that high levels of 13 particular types of the compound were associated with rosacea and may serve as more specific markers for the disorder. Since a general increase of oligosaccharides may not necessarily be specific to rosacea, they emphasized that the types of oligosaccharides found in greatest abundance in rosacea patients should be evaluated in further research for their specificity as markers for ocular rosacea.
Ocular rosacea often goes undetected because symptoms tend to develop separately from the facial signs of the disorder. Thirty-eight percent of the NRS survey respondents said their eye symptoms developed after the facial symptoms, while 17 percent said they occurred before. Just 15 percent said both eye and facial symptoms appeared at the same time.
"We plan to further investigate which types of oligosaccharides are the best indicators of rosacea in order to achieve even greater accuracy in distinguishing ocular rosacea from normal patients," Dr. Mannis said.
Rosacea is a chronic disorder that primarily affects the cheeks, nose, chin or forehead, and is often characterized by flare-ups and remissions. It typically first appears at any time after age 30 as a flushing or redness that comes and goes.
Over time, the redness becomes ruddier and more persistent, and visible blood vessels may appear. Without treatment, bumps and pimples often develop, and in severe cases, the nose may become swollen and enlarged from excess tissue.
For information and educational materials on rosacea, write the National Rosacea Society, 800 S. Northwest Highway, Suite 200, Barrington, Illinois 60010, or call its toll-free number at 1-888-NO-BLUSH. Information and materials are also available on the society's Web site at www.rosacea.org, or via e-mail at rosaceas@aol.com.
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