Many young people have eyes that do not seem to be cooperating with their lifestyle. In particular, their eyes can be watery, red and sensitive to light with difficulty looking at a computer screen or concentrating focusing on the words on a page.
Often they think they may have conjunctivitis, which is a bacterial infection and been prescribed antibiotic eye ointment, but they will not improve. Often they have to work at home because they cannot handle the lights in the office or the dryness and lack of humidity with the air conditioning. They find it difficult to look at the light, and they get reactive watering. These are spells of symptoms which occur and then come back to normal. For that reason, it is often also thought of as being an allergy, but otherwise, the patient can feel well without any major medical problems and not have any allergies, not smoke, not take drugs and hence wonders why their eyes are troubling them.
Sometimes the eyelids are swollen shut when they wake and their eyes very sore, watery and red, as well as photophobic. They can look and feel uncomfortable. An ophthalmologist is trained to look closely at the surface of the eye including the tear film, which should cover smoothly the surface of the eye. If it is patchy, then they know that there is a degree of dryness, and if the oil glands around the eyelids know as the meibomian glands are clogged, this also contributes towards dryness.
If there are a lot of long eyelashes that have crusts at their bases, they can look beautiful but gathers debris which consists of trapped skin cells, oils, dirt and which provide a perfect environment for low-grade bacteria to grow. The low-grade bacteria causes local inflammation which further accentuates the symptoms.
On looking at the slit lamp, which essentially is a microscope, and putting in some fluorescein eye drops which bind to dead or dying cells on the surface of the eye, this will reveal corneal ulcers, dry spots, early tear breakup time and punctate epithelial changes. The cornea then, therefore, is under long-term attack, and it sends out chemical mediators saying “I need more oxygen, I need more blood flow”. It makes it very difficult for the patient to wear contact lenses because they keep getting corneal ulcers and redness.
They can even get herpes simplex virus keratitis or merely an overgrowth of staphylococcal bacteria, which is a common bacteria found on our skin. But most commonly the problem stems from inflammation causing dryness. That inflammation may well be caused by an ocular rosacea, which is a condition, which is better known for causing the red skin on the face across the nose and cheeks. Inflammation from the toxin caused by staphylococcal bacteria on the eye can cause an ulcer on the eye. Therefore, as ophthalmologists, we look for rosacea and treat it medically, systemically and topically.
Often there is a family history of rosacea of the skin, known as acne rosacea. Ocular rosacea differs slightly as the skin does not have to be involved, but may be. Those who have acne rosacea may well have eye involvement and about 20% of the time the acne rosacea first presents itself with an ocular rosacea. Genetic and environmental triggers play a role in the development of rosacea.