Keratitis, rosacea

Keratitis, rosacea: A condition affecting the eyes in a disease called rosacea (see below). About half of all people with rosacea feel burning and grittiness of the eyes (conjunctivitis). If this is not treated, the complications of rosacea keratitis (inflammation of the cornea) may impair vision. Rosacea is a chronic skin disease that affects the middle third of the face with persistent redness over the areas of the face and nose that normally blush: mainly the forehead, the chin and the lower half of the nose. The tiny blood vessels in these areas enlarge (dilate) and become more visible through the skin, appearing like tiny red lines (called telangiectasias). Pimples can occur that look like teenage acne. Unlike acne, rosacea is not primarily a plague of teenagers. It occurs most often in adults (ages 30 to 50), especially those with fair skin, and affects both sexes but tends to be more common in women but worse in men. Unlike acne, there are no blackheads or whiteheads in rosacea. When rosacea first develops, it may appear, then disappear, and then reappear. However, in time the skin fails to return to its normal color and the enlarged blood vessels and pimples arrive. Rosacea rarely reverses itself. It lasts for years and, untreated, it worsens. Untreated rosacea can cause a condition called rhinophyma (ryno-fee-ma), literally growth of the nose, characterized by a bulbous, enlarged red nose and puffy cheeks (like the old comedian W.C. Fields). There may also be thick bumps on the lower half of the nose and the nearby cheek areas. Rhinophyma occurs mainly in men. Rosacea can be treated but not cured. Over-the-counter medications for acne can be a hazard; they can irritate the skin in rosacea. Topical antibiotics (such as metronidazole) and oral antibiotics (such as tetracycline) are often used. Short-term topical cortisone (steroid) preparations of the right strength may also be used to reduce local inflammation. Avoiding smoking and food and drink (such as spicy food, hot beverages and alcoholic drinks) that cause flushing helps minimize the blood vessel enlargement. Limiting exposure to sunlight and to extreme hot and cold temperatures also helps relieve rosacea. Rubbing the face tends to irritate the reddened skin. Some cosmetics and hair sprays may aggravate redness and swelling. Facial products such as soap, moisturizers and sunscreens should be free of alcohol or other irritating ingredients. Moisturizers should be applied very gently after any topical medication has dried. When going outdoors, sunscreens with an SPF of 15 or higher are needed. Cover-up make up is used for the telangiectasias. Telangiectasias can be treated with a small electric needle, a laser or surgery to close off the dilated blood vessels. Rhinophymas are treated by surgery. The excess tissue is removed with a scalpel, laser or electrosurgery. Dermabrasion can help improve the look of the scar tissue.