Acne and eye

1. ACNE AND EYE
Rashad Ibn Muhammed
M Optom 2nd sem student
Amity University Gurgaon

2. WHAT IS ACNE ??
 Acne vulgaris (or simply acne) is a chronic
skin condition characterized by areas
of blackheads, whiteheads, pimples, greasy
skin, and possibly scarring
 ICD-10 = L70.0
 ICD-9 = 706.1

3.  Acne mostly affects skin with a greater
number of oil glands; including the face,
upper part of the chest, and back.
 During puberty in both sexes, acne is often
brought on by an increase in androgens such
as testosterone.

4. SIGNS AND SYMPTOMS
 Typical features of acne
include seborrhea (increased oil-sebum
secretion),microcomedones,
comedones, papules, pustules, nodules (larg
e papules), and possibly scarring.
 The appearance of acne varies with skin
color. It may result in psychological and
social problems.

5.  Scars
Acne scars are the result of inflammation
within the dermal layer of skin
 Pigmentation
Post inflammatory hyper pigmentation
(PIH) is usually the result of nodular or cystic
acne. They often leave behind an inflamed red
mark after the original acne lesion has resolved.
PIH occurs more often in people with darker
skin color

7. ETIOLOGY
 Hormonal
 Genetic
 Psychological
 Infectious
 Diet

8. HORMONAL
 Hormonal activity, such as menstrual
cycles and puberty, may contribute to the
formation of acne.
 During puberty, an increase in sex hormones
called androgens cause the follicular glands
to grow larger and make more sebum

9. PSYCHOLOGICAL
 While the connection between acne and
stress has been debated, scientific research
indicates that increased acne severity is
associated with high stress levels

10. INFECTIOUS
 Propionibacterium acnes (P. acnes) is
the anaerobic bacterium species that is
widely suspected to contribute to the
development of acne lesions.

11. DIET
 High glycemic load diet is associated with
worsening acne.
 There may be a relationship between acne
and insulin metabolism and one trial found a
relationship between acne and obesity

12. PATHOPHYSIOLOGY
 Acne develops as a result of blockages in
the follicles.
 Hyperkeratinization and formation of a plug
of keratin and sebum (a microcomedo) is the
earliest change.
 Sebaceous glands enlargement and an increase
in sebum production occur with
increased androgen.
 The microcomedones may enlarge to form an
open comedo (blackhead) or closed comedo.

13.  Comedones result from the clogging of sebaceous
glands with sebum, a naturally occurring oil, and
dead skin cells.
 In these conditions, the naturally occurring
largely commensal bacterium Propionibacterium
acnes can cause inflammation within and around
the follicle

15.  leading to inflammatory lesions (papules,
infected pustules, or nodules) in
the dermis around the microcomedones or
comedones,
 which results in redness and may result
in scarring or hyper pigmentation. Severe
acne is inflammatory
 But acne can also be noninflammatory

17. DIAGNOSIS
 There are multiple scales for grading the
severity of acne vulgaris
 Leeds acne grading technique: Counts and
categorizes lesions into inflammatory and non-
inflammatory (ranges from 0–10.0).
 Cook's acne grading scale: Uses photographs
to grade severity from 0 to 8 (0 being the least
severe and 8 being the most severe).
 Pillsbury scale: Simply classifies the severity of
the acne from 1 (least severe) to 4 (most
severe).

18. MANAGEMENT
 Many different treatments exist for acne
including benzoyl peroxide,
antibiotics, retinoids, anti seborrheic
medications, anti-androgen
medications, hormonal treatments, salicylic
acid, alpha hydroxy acid, azelaic
acid, nicotinamide, and keratolytic soaps
 VPL – variable pulse light

19.  They are believed to work in at least four
different ways, including the following:
 Normalizing skin cell shedding and sebum
production into the pore to prevent blockage
 killing P. acnes
 Anti -inflammatory effects
 Hormonal manipulation

20. ACNE

21. SPOTS

22. THREADS AND BLOOD VESSELS

23. WRINKLES

24. HAIRS

25. ACNE ROSACEA

26.  Rosacea (rose-AY-sha) is a common skin
disease.
 It often begins with a tendency to blush or
flush more easily than other people.
 The redness can slowly spread beyond the
nose and cheeks to the forehead and chin.
Even the ears, chest, and back can be red all
the time.

27. ROSACEA HAS FOUR SUBTYPES:
 Erythematotelangiectatic rosacea:
Redness, flushing, visible blood vessels.
 Papulopustular rosacea: Redness,
swelling, and acne-like breakouts.
 Phymatous rosacea: Skin thickens and has
a bumpy texture.
 Ocular rosacea: Eyes red and irritated,
eyelids can be swollen, and person may
have what looks like a sty.

28. SIGNS AND SYMPTOMS

29. 1. ERYTHEMOTELANGIECTATIC
ROSACEA.
 Flushing and redness in the center of the
face.
 Visible broken blood vessels (spider veins).
 Swollen skin.
 Skin may be very sensitive.
 Skin may sting and burn.
 Dry skin, roughness or scaling.
 Have a tendency to flush or blush more
easily than other people.

31. 2.PAPULOPUSTAULAR ROSACEA.
 Acne-like breakouts, usually where the skin
is very red.
 Acne-like breakouts tend to come and go.
 Oily skin.
 Skin may be very sensitive.
 Skin may burn and sting.
 Visible broken blood vessels (spider veins).
 Raised patches of skin called plaques
(plaks).

33. 3.PHYMATOUS ROSACEA
 Bumpy texture to the skin.
 Skin begins to thicken, especially common on
the nose. When the skin thickens on the nose, it
is called Rhinophyma (rye-NO-fie-ma).
 Skin may thicken on the chin, forehead, cheeks,
and ears.
 Visible broken blood vessels appear.
 Pores look large.
 Oily skin.

34. AN ENLARGEMENT OF THE NOSE SECONDARY TO SEBACEOUS GLAND
HYPERTROPHY.

35. 4- OCULAR ROSACEA
 Watery or bloodshot appearance.
 Feel gritty, often feels like sand in the eyes.
 Eyes burn or sting.
 Eyes are very dry.
 Eyes itch.
 Eyes sensitive to light.
 Blurry vision.
 Visible broken blood vessels on an eyelid.
 Cyst on the eyelid.
 Person cannot see as well as before.

38. For the diagnosis of this case 1 or more of the
following symptoms should coexist with rosacea
 Continuous or transit Conjunctival redness
 The sense of foreign body in the eye
 blurry vision, tingling or burning or overly photo
sensitivity
 appearance of telangiectasia within the
conjunctiva or swollen or redness around the
eye
 inflammation of eyelids (Blepharitis) or
conjunctivitis (Conjunctivitis) or irregular eyelid
border.

39. WHO GETS ROSACEA?
 Rosacea is common. According to the U.S. government
 Between 30 and 50 years of age.
 Fair-skinned, and often have blonde hair and blue eyes.
 From Celtic or Scandinavian ancestry.
 Likely to have someone in their family tree with rosacea or
severe acne.
 Likely to have had lots of acne — or acne cysts and/or
nodules.
 Women are a bit more likely than men to get rosacea.
Women, however, are not as likely as men to get severe
rosacea.
 Some people are more likely to get rosacea, but anyone can
get this skin disease. People of all colors get rosacea.

40. WHAT CAUSES ROSACEA?
 Rosacea runs in families. Many people
who get rosacea have family members who
have rosacea. It is possible that people
inherit genes for rosacea.
 The immune system may play a role.
Scientists found that most people with acne-
like rosacea react to a bacterium (singular for
bacteria) called bacillus oleronius. This
reaction causes their immune system to
overreact.

41.  A bug that causes infections in the intestines may
play a role. This bug, H pylori, is common in people
who have rosacea. Scientists cannot prove that H
pylori can cause rosacea. Many people who do not
have rosacea have an H pylori infection.
 A mite that lives on everyone’s skin, demodex,
may play a role. This mite likes to live on the nose
and cheeks, and this is where rosacea often appears.
Many studies found that people with rosacea have
large numbers of this mite on their skin. The problem
is some people who do not have rosacea also have
large numbers of this mite on their skin.

42.  A protein that normally protects the skin
from infection, cathelicidin, may cause
the redness and swelling. How the body
processes this protein may determine
whether a person gets rosacea.

43. HOW DO DERMATOLOGISTS TREAT
ROSACEA?
 To treat rosacea, a dermatologist first finds all of
the patient’s signs and symptoms of rosacea.
This is crucial because different signs and
symptoms need different treatment.
Medicine that is applied to the rosacea are;
 Sunscreen (wearing it every day can help
prevent flare-ups).
 An emollient to help repair the skin.
 Lasers and other light treatments.
 Antibiotics (applied to the skin and pills).

44. Dermatologists can remove the thickening
skin that appears on the nose and other
parts of the face with:
 Lasers.
 Dermabrasion (procedure that removes
skin).
 Electrocautery (procedure that sends electric
current into the skin to treat it).

45. ROSACEA

47. EVAPORATIVE DRY EYE
 Due to decreased secretion of oils/lipids
 Decreased oil film on tear
 Glands of meibomian and zeiss
 NIBUT / TBUT
 More viscous tear substitutes

48. REFERENCES
Books
 Ak khurana Comprehensive Ophthalmology 5th
edition, 1 :5 :112
 Jack h palay, Cornea atlas 2nd edition,2: 22-23
 Kanski. Jack J Clinical Ophthalmology: A
Systematic Approach, 7th Edition
Websites
 http://en.wikipedia.org/wiki/Acne_vulgaris
 https://www.aad.org/dermatology-a-to-z/diseases-
and-treatments/q---t/rosacea
 http://www.yourenew.co.za/faq.php

49. QUESTIONS
1. The major causing bacteria for acne is
2. The bacteria that can metabolize its need
without oxygen is called as
3. What is Rhinophyma
4. Acne occurs between 13 to 21 and rosacea
occurs at?