Ocular rosacea in childhood

Oklahoma City University, Oklahoma City, Oklahoma, United States
American Journal of Ophthalmology (Impact Factor: 3.87). 02/2004; 137(1):138-44. DOI: 10.1016/S0002-9394(03)00890-0
Source: PubMed


To describe the clinical characteristics and treatment response of ocular rosacea in the pediatric population.
Retrospective case series.
The clinic charts of consecutive pediatric cases of ocular rosacea were evaluated over a 34-month period. Minimal diagnostic inclusion criteria were the presence of posterior eyelid inflammation including meibomian gland inspissation and lid margin telangiectasis, in conjunction with conjunctival injection or episcleritis.
Six patients ranged from 3 to 12 years of age at presentation. All shared a long history of ocular irritation and photophobia. Five patients (83%) were female and had bilateral involvement. Eyelid telangiectases and meibomian gland disease were present in all cases. Three patients (50%) had sterile corneal ulcers. Only two patients (33%) had cutaneous involvement at the time of diagnosis. All patients experienced significant improvement with a combination of oral antibiotics (doxycycline or erythromycin), with or without topical antibiotics (erythromycin or bacitracin) or topical steroids (fluorometholone).
Ocular rosacea in children may be misdiagnosed as viral or bacterial infections. Unlike in adults, associated cutaneous changes are uncommon. Most disease is bilateral, although involvement may be asymmetric. Response to conventional treatment is excellent, although long-term treatment may be necessary to prevent relapses.

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    ABSTRACT: Ocular rosacea forms part of the clinical spectrum of rosacea. It is characterized by a chronic and recurrent inflammation of the eyelids, conjunctiva and cornea. Approximately 50% of rosacea patients present ocular manifestations, and the condition is most frequently diagnosed when cutaneous signs and symptoms are present. However in 20% of patients, ocular manifestations may precede the cutaneous disease. Most frequent ocular symptoms are: red eyes, burning, foreign body sensation, photophobia and blurred vision. Chronic blepharitis with meibomian gland dysfunction is the most frequent ocular manifestation of the disease, and produces evaporative dry eye with consequent ocular surface damage. Corneal inflammation and scarring may be a cause of severe visual loss. In addition to therapeutic strategies for the cutaneous disease, ocular rosacea treatment involves, lid hygiene, topical macrolides and tetracyclines as eyelid gels or ointments, lubricant eye drops, and short-term topical steroids, depending on the severity of blepharitis, conjunctivitis and keratitis. Prognosis and visual outcome depend on the severity of the disease, early diagnosis and appropriate treatment.
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