Pediatric ocular rosacea, a misdiagnosed disease with high morbidity: Proposed diagnostic criteria

Abstract

Ocular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children. A clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola/chalazions and conjunctival/corneal phlyctenules evolving to neovascularization and scarring may occur. Visual impairment and consequent amblyopia are frequent and corneal perforation although rare is the most feared complication. Ocular manifestations usually precede cutaneous lesions. Although few cases of pediatric ocular rosacea (POR) have been reported in the literature, many cases must have been underdiagnosed or misdiagnosed. The delay in diagnosis is greater than one year in the large majority of cases and may lead to serious ocular sequelae. This review aims to highlight the clinical features of POR, its epidemiology, easy diagnosis and effective treatment. We also propose new diagnostic criteria, in which at least three of the five clinical criteria must be present: (1) Chronic or recurrent keratoconjunctivitis and/or red eye and/or photophobia; (2) Chronic or recurrent blepharitis and/or chalazia/ hordeola; (3) Eyelid telangiectasia documented by an ophthalmologist; (4) Primary periorificial dermatitis and/ or primary features of rosacea; and (5) Positive familial history of cutaneous and/or ocular rosacea.

Ocular Rosacea—a Review

“…Cetinkaya et al 45 have described pediatric ocular rosacea as a combination of meibomian gland disease, chronic blepharitis, recurrent chalazia along with long standing symptoms of ocular irritation, redness and photophobia which do not respond to routine medical treatment. A recent publication by Coimbra et al 46 have given a proposed diagnostic criterion according to which if ≥3 of the five criteria are present ( Table 3).…”

Efficacy of treatments for rosacea in the pediatric population: A systematic review

“…5 In addition, ocular involvement tends to be more common in pediatric patients, with eye manifestations more commonly preceding cutaneous features. 6 While treatment guidelines for rosacea are available, these are based on evidence that does not include children. 7,8 Due to the lack of consensus on the standard of care for rosacea specific to the pediatric population, we performed a systematic review of published literature aimed at identifying the efficacy of reported treatments used for pediatric rosacea to support future guideline development.…”

“…In addition to the subtypes mentioned above, there is also a pediatric specific subtype of rosacea referred to as aseptic facial granuloma (AFG) 5 . In addition, ocular involvement tends to be more common in pediatric patients, with eye manifestations more commonly preceding cutaneous features 6 …”

Blepharitis and Demodex spp. infection

“…occurs in 40% of people of a medical profession such as doctors, nurses, and physiotherapists, and in 33.7% of medical students and 23.5% of drug abusers. Ocular demodicosis can be a result of the presence of mites on the facial skin [17][18]. Demodex spp.…”