CORNEA EWAP JUNE 2022 25 stress, Dr. de Luise said. He said that a newer, updated classification of rosacea by the American Academy of Dermatology is now by phenotype. “Using a targeted therapy for each of these phenotypes/subtypes is now the preferred strategy of care by dermatologists,” he said. 1 Impact of oculocutaneous rosacea on the ocular surface Dr. de Luise discussed the corneal and ocular surface manifestations of ocular rosacea, which he described as protean and including anterior blepharitis, posterior blepharitis (meibomitis and meibomian gland dysfunction), eyelid telangiectasias, madarosis, punctate epithelial keratopathy, chalazion formation, corneal neovascularization, subepithelial infiltrates, and spade-like peripheral infiltrates. Some of the dermatological aspects of rosacea, such as facial yushing, are reversible. Other changes, such as severe rhinophymatous nasal changes, may be long lasting, he said. Oculocutaneous rosacea can lead to inyammation with associated ulceration and scarring, Dr. Cheung said. -uperficial changes can often be improved or reversed. “In the later stages, it can be difficult to reverse stromal thinning, scarring, or the associated neovascularization that develops,” he said. Dr. Perry said that ocular rosacea needs to be treated months before cataract surgery. He added that Demodex folliculorum is frequently associated with rosacea, noting the importance of treating the Demodex infestation before surgery as well. “You have to look at the eyelashes and see if there is cylindrical dandruff,” he said. The cylindrical dandruff indicates in 80–90% of patients the presence of Demodex mites. Patients may also have ocular inyammation. º9ou have to think of treating not only the rosacea because that will reyect the presence of increased amounts of bacteria, but you have to also eradicate the Demodex,” Dr. Perry said. Demodex carry Staph bacteria on their surface and Bacillus oleronius and cereus in their gut. Treatment strategies Patients with oculocutaneous rosacea benefit from avoiding triggers, such as certain foods, beverages, medications, and environments that exacerbate yushing, Dr. heung said. Additionally, certain systemic antibiotics (e.g., oral doxycycline/tetracycline, azithromycin) can treat both ocular and cutaneous rosacea. Other treatment strategies are based on the type of ocular pathology, he said. Meibomian gland dysfunction and blepharitis treatment often begins with conservative treatments. “This can include warm compresses, eyelid scrubs, and digital massage,” Dr. Cheung said. “Other therapies include oral omega-3 fatty acid supplementation, topical antibiotics, microblepharoexfoliation, heat application with/ without eyelid mechanical stimulation, meibomian gland probing, and intense pulsed light.” Related dry eye can benefit from frequent preservative-free artificial tearsÉointments, punctal occlusion, anti-inyammatory agents (cyclosporine, lifitegrast, low-dose topical corticosteroids), and autologous serum tears, Dr. Cheung said. Treatment of conjunctivitis and keratitis may benefit from topical corticosteroids and anti-inyammatory agents. If there is any infiltrate or ulceration, cultures and topical anti-microbial treatment is advised prior to corticosteroids, he said. “For severe ocular surface disease, scarring and thinning may cause irregular astigmatism and benefit from a hard contact lens for visual rehabilitation,” Dr. Cheung said. “Although rare, stromal thinning and perforations may need a bandage contact lens, cyanoacrylate gluing, amniotic membrane, tarsorrhaphy, conunctival yap, andÉor lamellar keratoplasty.” Dr. Cheung noted that he does not have much experience with meibomian gland probing and intense pulsed light, but he has found the other treatment options effective with a patient-specific regimen. Dr. Perry noted that there are several good treatments Peripheral keratitis in rosacea Source (all): Vincent de Luise, MD
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