I must admit that in 13 years of co-managing referred patients, I haven’t always given lids the attention they deserve. They got in the way of looking at important things like the cornea, lens and retina. But recently, lid problems, and specifically ocular rosacea, have provided my most challenging cases and appreciative patients.

My interest in lid disease grew out of necessity. Although research is providing better understanding and improved weapons for treatment, unfortunately, signs and symptoms rarely coincide. This makes early intervention a hard sell and compliance difficult. But, as primary eye care physicians, we can help with both the clinical and social ramifications of this challenging disease. Here are some highlights of what I’ve learned.

You’ve heard of the Terminator. I call rosacea the Inflamminator because of its slow, insidious inflammation and destruction.

• Click here to view 4 subtypes of this disease.
• It is a common, chronic, inflammatory eruption in the flush areas of the face (forehead, nose, cheeks and chin).
• It is most common in Caucasians over age 30.
• It is more common in women, but often more severe in men.
• Its features include erythema, telangiectasia, papules and pustules.

Although more common in women, we suspect rosacea less because makeup conceals fine surface blood vessels on the cheeks and nose. Progression is subtle and becomes more severe with time.

To evaluate the meibomian gland function, apply pressure along the lower lid, just below the lash line. Normal secretion should be thin and slightly yellow producing an oily look to the tear film. You won’t see this in rosacea or MGD patients. If you’re lucky you’ll get a thickened, white, cheesy discharge which gives you hope for treatment (Fig. 2). Often, there is complete obstruction and nothing will emerge—even with the aid of wood handled cotton swabs.

Management of rosacea should be tailored toward improving gland function, reducing inflammation, and relieving symptoms while treatment takes effect.

I recommend starting treatment with topical steroids and artificial tears. This will yield results and give patients confidence to hang with you.

In a world where it is common for eye surgeons to compete with their optometric colleagues, often denigrating them for not having the medical training they themselves have achieved, Pacific Cataract and Laser Institute thinks differently. We embrace optometry and recognize you as highly skilled primary eye care specialists. Rather than compete, we work hard to establish professional relationships built on trust and mutual respect. We are simply here to support you when you need help with secondary medical care or surgery.

Although some surgeons hold on to referred patients, our practice is to treat patients for the condition they were referred and then return them to their family eye doctor for follow-up care as soon as they are stable.