Why Rosacea makes Your Eyes Burn

Rosacea doesn’t just affect the skin, it can inflame the eyes and eyelid margin. The eyelids contain meibomian glands which secrete oils to stabilise your tear film and prevent your tears from evaporating too quickly, causing dry eyes.

Rosacea can disrupt this process in multiple ways

Physical blockage of the meibomian glands

In rosacea, there is an abnormal increase in epithelial cell turnover. This causes hyperkeratinisation, build up of dead epithelial cells on the eyelid margin, physically blocking the meibomian gland opening. This prevents normal meibum secretion from the glands which can lead to permanent atrophy of the meibomian glands.

Chronic Inflammation

Rosacea involves an excessive activation of the innate immune system. The overactive immune response leads to a high level of inflammatory cells in the tears which breaks down the surrounding tissue causing chronic inflammation

Demodex mites

People with rosacea often have an overgrowth of demodex mites. These mites naturally live on our skin but when overgrowth in our sebaceous glands and hair follicles occurs, the waste products of these mites cause irritation and heightened immune response causing chronic inflammation.

Vascular change and talengectasias

Ocular rosacea causes abnormal vasodilation and the formation of talengectasia (new, small blood vessels) in the meibomian glands, the eyelid margins and conjunctiva. These vessels are ‘leaky’ and secrete inflammatory cytokines which contributes to the vicious cycle of inflammation and symptoms of burning and irritated eyes.

Neurovascular dysregulation

Rosacea causes abnormally heightened sensitivity to environmental stimuli (sun exposure, heat, alcohol, spicey food, caffeine) leading to increased vasodilation, permeability and release of inflammatory cells.