Ocular rosacea in childhood

ArticleinAmerican Journal of Ophthalmology 137(1):138-44 · February 2004with14 Reads
DOI: 10.1016/S0002-9394(03)00890-0 · Source: PubMed
Abstract
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.
    • "Most children with BKC do not have facial skin changes but there is an association with atopic dermatitis and acne vulgaris. In children, the association of BKC with facial rosacea is less common than in adults [9] , but its prevalence is possibly underestimated [10] and acne vulgaris and rosacea should be considered if ocular symptoms associated with facial dermatosis [11]. The ophthalmologist should be able to distinguish acne vulgaris from papulopustolar rosacea. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Childhood blepharokeratoconjunctivitis is a common lid margin inflammation with secondary ocular surface disease. Its etiology is unclear and there are no randomized controlled trials to support the superiority of any treatment option. Areas covered: We searched the following databases; Cochrane Central Register of Controlled Trials, Ovid MEDLINE and affiliated Ovid databases, EMBASE, the ISRCTN registry, Clinical- Trials.gov and the World Health Organization International Clinical Trials Registry Platform. Due to the paucity of pediatric data we also considered information from articles focused on adults. Expert Commentary: Treatment is based on the assumption that the mechanisms of BKC and rosacea keratitis are the same: meibomian gland dysfunction, bacterial colonisation of the lid margin, delayed type hypersensitivity, Demodex folliculorum, genetic predisposition and Toll-like receptors inducing release of pro-inflammatory cytokines. Generally accepted grading scales are needed. Randomized clinical trials are needed to evaluate treatment options. The effects of antibiotics, immunomodulators, osmoprotectants and essential fatty acids need further investigation. Keywords: blepharokeratoconjunctivitis, blepharoconjunctivitis, blepharitis, dry eye disease, meibomian gland disease
    Full-text · Article · Jul 2016
    • "[11] Ocular manifestations of rosacea in children are similar to adults, but sight-threatening complications are more frequently found at this age group. [47] [48] Children are likely to have a family history of rosacea, and the condition may persist through adulthood. [49] [50] In general, rosacea flushing usually initiates during the second decade of life, becomes troublesome at the third decade, and may continue to progress thereafter. "
    [Show abstract] [Hide abstract] 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.
    Chapter · Jan 2016 · Expert Review of Ophthalmology
    • "[11] Ocular manifestations of rosacea in children are similar to adults, but sight-threatening complications are more frequently found at this age group. [47] [48] Children are likely to have a family history of rosacea, and the condition may persist through adulthood. [49] [50] In general, rosacea flushing usually initiates during the second decade of life, becomes troublesome at the third decade, and may continue to progress thereafter. "
    [Show abstract] [Hide abstract] 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.
    Chapter · Apr 2015 · Expert Review of Ophthalmology
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