Ocular rosacea: an underdiagnosed cause of relapsing conjunctivitis-blepharitis in the elderly

Abstract

Red eye and relapsing conjunctivitis-blepharitis are among the most common ocular disease in elderly patients. In these cases the search for causes is difficult and frustrating. We report the case of a 79-year-old woman with a long history of red eye and relapsing conjunctivitis-blepharitis caused by ocular rosacea. In this patient the proper diagnosis was performed after 10 years of ocular disease, and repeated evaluations by general practitioners and clinical specialists, only after the appearance of facial signs of erythematotelangiectatic rosacea. Adequate therapy with oral doxycycline led to the improvement of the clinical picture that previously had shown a poor response to several topical treatments. The possibility of ocular rosacea should be considered in evaluating an elderly patient with persistent red eye and relapsing conjunctivitis-blepharitis. Making the proper diagnosis is crucial because ocular rosacea does not respond as expected to topical therapy and may lead to severe corneal involvement.

A Rare Coexistence of Isolated Unilateral Conjunctival Telangiectasia and Retinal Vascular Tortuosity

“…Last but not least, some acquired causes such as chronic phases of some ocular surface disorders should also be considered in the differential diagnosis of conjunctival telangiectasia [ 3 , 17 , 18 ]. Of these, ocular rosacea is the mostly encountered one.…”

Therapeutical Management for Ocular Rosacea

“…Ocular manifestations may precede, follow or occur simultaneously with skin changes, but most commonly they develop jointly. The most common ocular signs include blepharitis, conjunctival injection, eyelid margin telangiectasias, changes in the Meibomian glands such as chalazion or stye or scales and crusts on the eyelids [ 5 , 8 , 9 ].…”

“…The predominant symptom is ocular blepharoconjunctivitis [ 8 ], but up to 33% of the patients develop corneal injuries that can affect their vision seriously, mainly due to delayed diagnosis [ 9 ]. The dysfunction of the Meibomian glands can lead to evaporative dry eye syndromes.…”

Swiss S1 guideline for the treatment of rosacea

“…Ocular rosacea can include symptoms such as conjunctivitis, blepharitis, irritation, dryness or keratitis . The prevalence rates reported range from 3% to 72%; however, most sources assume a prevalence of more than 50% of all rosacea patients .…”

“…An ophthalmologist should be involved to confirm the diagnosis as it can also result in complications such as alterations of the lids, cornea, sclera and anterior chamber (uveitis). It is often accompanied by oedema of the lid or the periorbital regions . As differential diagnoses, bacterial and viral conjunctivitis as well as allergic conjunctivitis and infectious keratitis needs to be considered.…”