CORNEA 24 EWAP JUNE 2022 by Ellen Stodola Editorial Co-Director Signs of rosacea and how to treat Contact information Cheung: ACheung@cvphealth.com De Luise: vdeluisemd@gmail.com Perry: hankcornea@gmail.com Rosacea can be a significant problem for many patients and may be more prevalent than physicians think. Depending on the subtype, there may be ocular involvement. Albert Cheung, MD, Vincent de Luise, MD, and Henry Perry, MD, discussed treatment strategies, in addition to sharing what to look for and how to diagnose. Signs of oculocutaneous rosacea and diagnosis Dr. Perry said rosacea is a chronic disease that usually starts when patients are in their 20s or 30s. It’s a disease that has a fairly high prevalence, up to 10% in some parts of the country. He added that diagnosis is mainly one of inspection by people who have treated the disease for a long time or have it themselves. Many patients have the disease and aren’t aware of it. There are four types of rosacea, but usually we think of it being vascular or inyammatory, Dr. Perry said. For ophthalmologists, the most important part of rosacea is ocular rosacea, Dr. Perry said, but the other three are important as well because 50% of patients in those groups also have ocular symptoms. These include erythematotelangiectatic rosacea, papulopustular rosacea, and phymatous rosacea. Erythematotelangiectatic rosacea is a common form where there is scaling of the skin usually in the central face. Patients may have a tendency to yush, which can be eÝacerbated by cold, heat, alcohol, or sunlight. Papulopustular rosacea usually occurs in the central face and may look like acne vulgaris. Phymatous rosacea is commonly identified by a large bulbous nose and is caused by proliferation of vessels, hypertrophy of sebaceous glands, and thickening skin. Dr. Cheung said that cutaneous signs include erythemaÉyushing, papules and pustules, telangiectasias, and rhinophyma. While ocular symptoms are often related to burning, itching, redness, and foreign body sensation, the most common signs are meibomian gland dysfunction and blepharitis. “These patients can also have conjunctival injection, phlyctenules, and keratitis, ranging from superficial punctate keratitis to marginal infiltrates and ulceration.» In order to diagnose, Dr. Cheung said it helps to take a step back and look at facial features. Close examination of the eyelids at the slit lamp is also important, noting the presence of telangiectasias and hyperemia, presence of meibomian gland expression with pressure, quality of meibum, and presence of inspissation. Dr. Cheung added that there may be chalazia/ hordeola or history of these. Fluorescein can help highlight the previously mentioned corneal findings and lissamine green the conjunctival changes. This issue is more common in women and among patients middle-aged or older, Dr. Cheung said. Rosacea can yare up in response to certain triggers such as sun exposure or emotional This article originally appeared in the April 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Rosacea keratitis; spade-like peripheral infiltrates and peripheral keratoconjunctivitis.
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