Can it be ocular rosacea? Have tried some antibiotics without any relieve

[Galverad]

Hello there!

When I was ~15 I noticed that I had red veins in my eyes. Before that I were too shy to make eye contact and too geeky to care about how I looked so it's possible it started before...
However, now 5 years later it's same and I'm not really sure what do to. At first every doctor said it was allergy despite NO anti-allergy medication helps. About 2 years ago I finally went to an eye-doctor. He didn't say much but he gave me a look that he might know what the problem could be, then he dilated one pupil so I looked more brain damaged than usually. But he just scratched his beard, went 'hmm....?' and prescribed topical steroids. He thought it would remove the redness after 2 weeks of steroids...
After ~1 week it was almost back to normal.

I went to him again with the bad news. This time I got topical steroids and topical antibiotics against Staphylococcus. I have used that very same topical antibiotics against pink eye and asked him why it would help against my every day redness. Apparently the combination of steroids and antibiotics could help.
Which it didn't. (2 weeks on both)

After that he said there's nothing we can do about it. Kinda sad for hearing I left the clinic. A few months later I called them to get a copy of my journal, the lady in the phone said the doctor had given me the diagnosis blepharitis. Kinda confused since he never told me that in person I ran to my computer and googled it... I did have "Crusting at the lid margins, this is generally worse on waking.", sometimes "Cysts at the lid margin (hordeolum)." (but only very small)
Eyelid cleaning and warm compress got rid of the crusting, fewer "hordeolum" but the redness remains...

A month ago I heard of ocular rosacea and still wonder if it's possible that I have it. I have tested the lid cleaning but not any medications. My previously eye doctors just say "viral blepharitis" since the topical antibiotics didn't work.

What do you think?

[Melissa W]

Hi and welcome to the RF.

It's good that the eyelid cleaning and warm compresses are helping a major part of your eye problems. Continue with that regimen and you may want to add other treatments depending on your other symptoms. What are your other symptoms- burning, itching, tearing...?

What are you cleaning your lids/lashes with and how often are you doing this?

Check out the sticky thread in this section as there is lots of helpful info there for you. And yes, it can be ocular rosacea but that is just a catch-all diagnosis and the treatment depends on your signs and symptoms.

Best,
Melissa

[Galverad]

Thanks for the reply!

Other symptoms are mainly red veins, but they do often feel... I wouldn't say dry or burning, more like 'sandpaper'. But that is maybe the same as burning. No itching or tearing.

I think it was almost 1 year ago I first heard about lid cleaning. I have tried q-tips, warm compress, cold compress, only water, baby shampoo, lid scrubbing and lid massage...
I did hot compress twice a day, q-tips on the eyelids twice a day, baby shampoo massage in the shower each morning. That went on for 2 month until I gave up.
Some time I only did lid massage but cleaned my eyelashes Many times each day...

It all got rid of the crusting in the morning, I might had fewer "hordelums" but they are so small and not a problem by itself. I don't know if everyone got them now and then or if it's a sign of something...

Now I only clean my eye lashes each morning when I take a shower. Almost same effect as compress/massage but same redness.

I'm not sure if oral antibiotics in the combination of lid cleaning would help.

[Melissa W]

You might want to add preservative-free rewetting drops to your regimen. The foreign body effect could signify dryness so the drops would help add moisture back. Also, I would stop the baby shampoo and just cleanse with warm water and a compress and see if that keeps your lids clear. It doesn't sound as if you need a topical antibiotic.

Cool compresses might help with redness and comfort as needed.

Best,
Melissa

[Galverad]

Thanks for the reply Melissa!

I only mentioned the cleaning routine. I have tested like a million different 'Artificial tears', at first mainly with preservative now only without. At the moment I do use it regularly, it feel slightly better but my eyes are still red.
I have tested both with and without shampoo...

I agree that topical antibiotic might not help. Some patients with ocular rosacea get oral antibiotics, is that any huge different from topical?

After reading more about rosacea I must say that I do get red cheeks and forehead when I take a warm shower... I think this started ~2-3 years ago. I just thought my skin in sensitive and applied some moisture cream to my face after a shower. After ~30-45 minutes it's gone. Can it be the first sign of me developing rosacea?
But the red cheeks and forehead ain't a problem compared to my red eyes.

[Melissa W]

Another drop for you to try then is Restasis. It works by reducing inflammation that decreases tear film production so in theory if you have reduced tf production from inflammation this drop will benefit you.

I dislike recommending drops/treatments like this by trial and error as a proper eye exam should pinpoint the cause of your symptoms and then the treatment could be more specific but it seems the majority of people here are not getting the comprehensive eye exams necessary to pinpoint the exact cause. Unlike facial rosacea (IMO) ocular rosacea can be more easily treated for *most* people and symptoms alleviated.

Another option is for you to do some research and find a teaching hospital that does research re Ocular Rosacea and be examined and properly diagnosed there. Some of the treatments might be the same but some might be more specific.

In any case trial and error might need to be employed regardless once the exact diagnosis is made and the cause of your dry eye is identified (poor tear quality or reduced tear production (due to inflammation or another cause) or tear film insufficiency or eyelid problems or hormonal issues or medications causing dry eye etc) but it gives you a better starting point.

As far as if you have facial rosacea a dermatologist would be your best starting point. In the meantime act as you do and protect your face from the sun (sunblock), extreme temps, use a minimum of gentle products and stay away from known triggers (within reason).

[Galverad]

Thanks for the tip of restasis, I have heard of it before but I don't know if it exist in my county or the name of it here.

I don't follow your recommendations just because you say so, I understand that it's hard to help without misleading. But anything I hear of I will google and see if it's likely it might help me. Things I can do without harming me I will try. Like I will try some flaxseed oil now and other stuff. I have nothing to loose and any tip is really useful!

I only find doctors for normal Rosacea here and I can't really see anything on my face so I'm not sure if they will see me.

I try to find information about triggers for ocular rosacea. Does sunlight affect the redness of your eyes or only eyelids and other part of your skin? Better/worse different times of the day?

[Galverad]

Still waiting to see the doctor and bring this up. However I have one final(?) question. Can they "tell" if I have ocular rosacea, like saying "I can see X but not Y... so you have it/dont have it". Or is it more like I explain my problems and the doctor can more say if it sounds like rosacea or not.
I haven't heard of any test for it.