Rosacea and Dry Eyes Part 5 - how did Rosacea “happen” to me?

Representation of a wild bovid, the Banteng, made in ochre, discovered in the Lubang Jeriji Saléh cave, East Kalimantan, Borneo, Indonesia, dated to 40 ka. Discovered in 1997 by Kalimanthrope (Pindi Setiawan, Luc-Henri Fage and Jean-Michel Chazine), it was dated to -40,000 BP in 2018 by Aubert & ali. and remains one of the oldest samples of figurative rock painting. This image appeared on Wikipedia's Main Page in the Did you know? column on 17 December 2018.

I’ve mentioned in a (much) earlier post that I have Rosacea, too. In thinking about how this might have “happened,” I like to think in evolutionary terms - and since it affects me, I like to think of it as a form of “higher evolution;)”

One of my premises about how dry eye evolved, begins with the notion that our great-great-great ancestors (thinking many hundreds of thousands of years ago and beyond) were characterized as the “hunter-gatherers.” These simple folk subsisted off the fish, nuts and seeds - or animals that ate the same fish, nuts and seeds (note the above cave drawing) - because way back then, there apparently was little else to eat back then. Those same folk generally lived in caves or some form of hovel (apart from the aristocracy that undoubtedly existed even then) - and lacking modern degrees of hygiene, one can assume these places were not up to today’s standards of cleanliness.

To survive as a species, we spent a lot of time hunting, gathering and procreating - but living in what we - today - would consider degrees of relative squalor, it was also obvious that we had to develop very strong immune systems to defend against the many germy threats that undoubtedly existed even then (and maybe especially then). Even as recently as Medieval times, we have history books that chronicle outbreaks of plagues, cholera, typhus and the like, which most historians blame on poor hygiene habits.

Without electricity, our ancestors were largely at the mercy of the sun for light, and to hunt and gather, most would likely spend the bulk of their days out in the wind and sun (where we learned to “blink strong” - a habit that would serve us well when it came to producing oil from our eyelid oil glands). The “peasant diet” of fish, nuts and seeds also served to supply the essential “building blocks,” which would nourish those same oil-producing glands - so our ancestors were oil producing machines - well adapted to the harsh environments we habitated - even if our life spans were pathetically short in those hard times.

Fast-forward to the past 100 years and there has been a huge increase in our lifespan (I commonly see patients in their 80s-90s and some 100s, when the average prehistoric was apparently 20s-30s to be considered an old man or woman). Add to that, the benefit of a controlled environment - clean, well lit and with a temperature regulated by HVAC systems that can keep our room temperature as warm or cold as we wish - and “life is good.”

Digital devices keep us connected around the globe, providing access to education and entertainment that even the enlightened Leonardo Da Vinci might not have dreamed of. Food has become relatively plentiful for the average American, too. Unfortunately, the foods we crave today generally are weak in the oil “building blocks” our ancestors ate (their fish, nuts and seeds being a rich source of Omegas 3,6 and 9). Scientists claim we Americans eat 95% less of these “essential oils” in the last 100 years, thanks to “processed foods” like Pizza, Pasta, Hamburgers, Hot Dogs (sorry Joe) and all the chips and pretzels we munch while watching those athletes who train and perform in the sun and wind while we relax indoors on a comfortable couch or lounge chair (except for Joe). Staring at those digital devices trains the oil-producing glands not to work (where strong blinks are the triggers that make them work).

Finally, we turn to the issue of Rosacea. We all carry genes programed in our immune systems to fight germs and provide lethal forces to the surface of the eye when it is sending SOS-distress signals to our defense system. Some of us (with rosacea genes) are more “programed” than others to “fight the good fight” - even if that means interpreting mild, innocuous germs as “the enemy” and sending our defenses into high gear when they should be on idle. We “Rosaceans” (I may have just cloned that word?) will gradually develop ruddy red faces, thanks to the dilating blood vessels carrying those potent defenses. Eyes can get red (and dry), too. Was this a “survival mechanism” that allowed some of us to better subsist and ultimately procreate in those dirty caves, so we could launch the next generation? Tough to think of it that way, but maybe that was the genetic hack that was needed in those harsh times - and here we are today, paying another price in older ages than those forebears would have imagined. That price can be a form of dry eye disease where the oils we produce can be more like a pro-inflammatory “kerosene” (my euphemism for the harsh oils common to rosacea) than like the healthy meibum oils we would wish for in our tears. More on this and the treatments to help with this, in my future posting.

To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:

(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020

(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463