Clinical, Meibographic, and Interferometric Evaluation in Children With Ocular Rosacea

Audelan, T; Martin, Gilles C.; Marciano, E.; Gillard, P.; Azar, Georges; Cochereau, Isabelle; Gabison, Éric; Doan, Serge

doi:10.1016/j.ajo.2021.12.004

Cited by 5 publications

(8 citation statements)

References 30 publications

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“…The diagnosis is based on cutaneous findings, even when ocular manifestations occur first . Ocular signs reported in childhood rosacea overlap considerably with PBKC, but severe corneal involvement with substantial visual loss is rare . The largest case series found only 11.9% of eyes developing significant vision loss related to corneal pathology .…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with previous reports are the prevalence of the disease, its underdiagnosis, potential visual consequences, its inflammatory condition, and the main clinical manifestations and ocular surface structures affected . We addressed the confusion arising from the variability of skin involvement by including it as an important but optional element in diagnosing PBKC …”

Section: Discussionmentioning

confidence: 99%

“…58,59 Ocular signs reported in childhood rosacea overlap considerably with PBKC, but severe corneal involvement with substantial visual loss is rare. 9,10,55,58,60 The largest case series found only 11.9% of eyes developing significant vision loss related to corneal pathology. 60 Most probable, PBKC and childhood rosacea are 2 different clinical entities sharing similar pathogenic mechanisms and ocular manifestations, with the latter differentiating from the former by typical cutaneous signs.…”

Section: Discussionmentioning

confidence: 99%

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Definition and Diagnostic Criteria for Pediatric Blepharokeratoconjunctivitis

Morales-Mancillas,

Velazquez-Valenzuela,

Kinoshita

et al. 2024

JAMA Ophthalmol

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ImportancePediatric blepharokeratoconjunctivitis (PBKC) is a chronic, sight-threatening inflammatory ocular surface disease. Due to the lack of unified terminology and diagnostic criteria, nonspecific symptoms and signs, and the challenge of differentiation from similar ocular surface disorders, PBKC may be frequently unrecognized or diagnosed late.ObjectiveTo establish a consensus on the nomenclature, definition, and diagnostic criteria of PBKC.Design, Setting, and ParticipantsThis quality improvement study used expert panel and agreement applying the non-RAND modified Delphi method and open discussions to identify unified nomenclature, definition, and definitive diagnostic criteria for PBKC. The study was conducted between September 1, 2021, and August 14, 2022. Consensus activities were carried out through electronic surveys via email and online virtual meetings.ResultsOf 16 expert international panelists (pediatric ophthalmologists or cornea and external diseases specialists) chosen by specific inclusion criteria, including their contribution to scientific leadership and research in PBKC, 14 (87.5%) participated in the consensus. The name proposed was “pediatric blepharokeratoconjunctivitis,” and the agreed-on definition was “Pediatric blepharokeratoconjunctivitis is a frequently underdiagnosed, sight-threatening, chronic, and recurrent inflammatory eyelid margin disease associated with ocular surface involvement affecting children and adolescents. Its clinical spectrum includes chronic blepharitis, meibomitis, conjunctivitis, and corneal involvement ranging from superficial punctate keratitis to corneal infiltrates with vascularization and scarring.” The diagnostic criteria included 1 or more suggestive symptoms accompanied by clinical signs from 3 anatomical regions: the eyelid margin, conjunctiva, and cornea. For PBKC suspect, the same criteria were included except for corneal involvement.Conclusions and RelevanceThe agreements on the name, definition, and proposed diagnostic criteria of PBKC may help ophthalmologists avoid diagnostic confusion and recognize the disease early to establish adequate therapy and avoid sight-threatening complications. The diagnostic criteria rely on published evidence, analysis of simulated clinical cases, and the expert panel’s clinical experience, requiring further validation with real patient data analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Definition and Diagnostic Criteria for Pediatric Blepharokeratoconjunctivitis

Morales-Mancillas,

Velazquez-Valenzuela,

Kinoshita

et al. 2024

JAMA Ophthalmol

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“…The FTBUT was shorter in patients with MGD than in those without MGD [ 16 ]. In addition to the commonly adopted lid margin and meibography evaluation of MG, quantification of lipid layer thickness (LLT) with or without interferometer instruments has become an important technology in the evaluation of MG function and treatment effects [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Subjective symptoms are one of the major diagnostic criteria in dry eyes.…”

Section: Introductionmentioning

confidence: 99%

Association between Dry Eye Parameters Depends on Tear Components

Chang

2022

JCM

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How tear components contribute to dry-eye symptoms/signs remains less well-defined. This observational cross-sectional study enrolled 4817 (F/M = 3590/1227) patients. Subjective symptoms were evaluated with the SPEED and OSDI questionnaires. Fluorescein tear breakup time (FTBUT), superficial punctate keratitis (SPK) grading, Schirmer scores, number of expressible meibomian glands (MGE), lipid layer thickness (LLT), blink/partial blink rates and meibography were recorded. Patients were divided into 4 types according to their Schirmer scores and LLT, i.e., Type 1 (N = 1494): Schirmer > 5 mm, LLT > 60 nm; Type 2 (N = 698): Schirmer > 5 mm, LLT ≤ 60 nm; Type 3 (N = 1160): Schirmer ≤ 5 mm, LLT ≤ 60 nm; Type 4 (N = 1465): Schirmer ≤ 5 mm, LLT > 60 nm. Lipid deficiency (LLT ≤ 60 nm) and aqueous deficiency (Schirmer score ≤ 5 mm) were found in 38.6% and 54.5% of patients, respectively. The majority (62.4%) of lipid-deficient patients were also aqueous deficient, while 44.2% of aqueous-deficient patients were also lipid-deficient. Type 3 patients (mixed type) had the highest symptom scores (p = 0.008 and 0.007 for SPEED and OSDI, respectively), more total blinks (p < 0.001) and the shortest FTBUT (p < 0.001). Stepwise multiple regression demonstrated that LLT and Schirmer score were significant contributors to FTBUT in all 4 types. The FTBUT correlated with SPK severity in all 4 types, with Schirmer score in types 1 and 4, and with LLT in type 3 patients. SPK correlated with LLT and MGE in types 1 and 4. Age correlated with dry eye parameters more significantly than sex. Subtyping by aqueous and lipid components facilitates the understanding of dry eye pathophysiology.

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“…B lepharokeratoconjunctivitis (BKC), one of the most common ocular surface disorders in children, [1][2][3][4][5] is a clinically diagnosed disease that involves acute or chronic inflammation of the eyelids, conjunctiva, and cornea, resulting in corneal opacity, neovascularization, and scarring. 3,4,[6][7][8][9][10][11][12] Because BKC causes various nonspecific symptoms such as ocular irritation, redness, watering, and itching sensation, it is easily overlooked or underdiagnosed in children. 3,4,13,14 Insufficient or delayed treatment of BKC can induce corneal opacity and irregular astigmatism, leading to amblyopia in pediatric patients.…”

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confidence: 99%

Clinical Characteristics and Therapeutic Outcomes of Pediatric Blepharokeratoconjunctivitis

Moon

Lee

Kim

et al. 2022

Cornea

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Purpose:The purpose of this study was to determine the clinical characteristics, disease course, therapeutic outcomes, and prognostic factors for pediatric patients with blepharokeratoconjunctivitis (BKC).Methods:A retrospective medical chart review was performed for patients aged 15 years or younger who had been diagnosed with BKC between 2004 and 2020 at 2 tertiary hospitals in Korea. The following data were collected: demographics, medical history, ocular findings, geometric profiling of corneal lesion, medical management, and outcomes.Results:A total of 137 patients (90 female and 47 male) were included. The patients’ mean age was 8.3 ± 3.8 years at disease onset. Both eyes were involved in 57.7% of cases. The most common corneal lesion was corneal neovascularization (77.4%), followed by clinically visible corneal infiltration (51.8%) and stromal scarring (43.1%). Most of the corneal lesions involved a single quadrant, most commonly the inferior quadrant. After treatment, disease remission was achieved in 95% of patients, and visual acuities improved from 0.2 ± 0.3 logarithm of minimal angle of resolution at disease presentation to 0.1 ± 0.3 logarithm of minimal angle of resolution at final follow-up (P = 0.001). Recurrence occurred in 52.6% of patients. Cylinder power was significantly higher in patients with recurrence than in those without. The number of cases of recurrence was positively associated with final cylinder power.Conclusions:Although the treatment induced disease remission in 95% of children with BKC, recurrence occurred in 52.6% of those cases. Because recurrence resulted in significant astigmatism, careful observation for recurrence and prompt management are warranted for preservation of vision in pediatric patients with BKC.

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Clinical, Meibographic, and Interferometric Evaluation in Children With Ocular Rosacea

Cited by 5 publications

References 30 publications

Definition and Diagnostic Criteria for Pediatric Blepharokeratoconjunctivitis

Definition and Diagnostic Criteria for Pediatric Blepharokeratoconjunctivitis

Association between Dry Eye Parameters Depends on Tear Components

Clinical Characteristics and Therapeutic Outcomes of Pediatric Blepharokeratoconjunctivitis

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