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Background The treatment of facial erythema and subjective symptoms of rosacea patients remains challenging in clinical practice. Cosmeceuticals, care components containing active ingredients such as phytochemicals, play a growing role in treatment plans. However, well-designed studies on their efficacy and limitations are widely missing. Objective A foam and a cream for rosacea patients were assessed based on objective and subjective methodology. The tolerability of skin and eyes was evaluated. Methods A randomized, double-blinded, split-face, and vehicle-controlled trial was conducted. At baseline and after four weeks of product use, dermatological and ophthalmological investigations were performed, employing image analysis of facial erythema, clinical assessments, and questionnaires. Results The patient cohort comprised 33 females with persistent facial erythema due to rosacea. No significant differences were found between the vehicle and the verum. According to the analysis of facial erythema, a "less pronounced" or "much less pronounced" appearance was seen in two thirds of patients comparing V1 to V0. Especially, the dryness of the skin improved by the use of the vehicle and the verum. Adverse subjective skin sensations decreased by 61.3% for the verum side and by 58.6% for the vehicle side. Subjective and objective analysis of ocular manifestation differed, with subjective manifestations reported more frequently, thus highlighting underdiagnosis of ocular rosacea. Conclusions As no clear differences between the verum and the vehicle were found, an optimal skin care regime itself seems to have a superior effect in the relief of facial erythema and foremost of subjective symptoms, rather than certain active ingredients.

Immune-related adverse events (irAEs) is a term used to describe the various toxicities associated with immune checkpoint inhibitor (ICI) use. As this class of cancer immunotherapy grows, the diversity of documented irAEs also continues to expand. Ocular toxicities secondary to ICI use are relatively rare, with dry eye and uveitis as the most frequently reported ocular side effects. This article specifically investigates the relationship between ocular surface disease and ICI therapy through a review of the existing literature. Dry eye disease (DED), conjunctivitis, and keratitis were the most commonly reported irAEs affecting the ocular surface across the 29 studies reviewed. Keratoplasty graft rejection was also described in two case reports. Our review of eight clinical trials found the incidence of DED, the most common ocular surface irAE, to range from 1 to 4%. Nearly all cases of ocular surface irAEs were graded as mild or moderate in severity and were often self-limited or controlled with conservative treatment. Duration of checkpoint inhibitor use prior to onset of ocular surface side effects varied widely, ranging from days to months. Ocular surface toxicities associated with checkpoint immunotherapy appear to be under-reported and under-investigated. Further work remains to be done to investigate the full breadth of ocular surface pathologies and the molecular mechanisms by which these toxicities occur.

Rosacea is a chronic inflammatory skin disease characterized by central facial erythema with or without ocular involvement. It is often difficult to distinguish rosacea from other malar rashes, one of which is acute cutaneous lupus erythematosus (CLE), particularly when there is an increase in antinuclear antibody (ANA) level. We report the case of a 16-year old woman with facial erythematous plaque accompanied by papules and pustules, reddened eyes, and swollen eyelids since the last one year. Dermoscopic examination revealed telangiectasia, and skin scraping examination with 20% potassium hydroxide identified the presence of Demodex folliculorum. Further ocular examination also revealed blepharitis, dysfunction of Meibomian gland, cicatrix, and corneal neovascularization. The ANA titer was positive (1:320), while the anti-dsDNA was negative. The patient was treated according to standard treatment for rosacea. The patient showed a satisfactory response following 2 weeks of therapy. Signs of recurring red patches with papules, pustules, telangiectasia, and identification of D. folliculorum on skin scraping examination led to the diagnosis of papulopustular rosacea. A positive ANA test may also be present in other diseases, e.g. acute CLE. Therefore, the diagnosis of rosacea remains a challenge. Thorough observation and examination must be done in order to yield an accurate diagnosis of rosacea.

Purpose To assess tear film transforming growth factor-beta (TGF-β) and ocular microbiome changes after intense pulsed light with meibomian gland expression (IPL-MGX) vs only MGX in treating ocular rosacea with dry eye symptoms. Methods Twenty patients were randomly assigned to IPL-MGX or MGX. Patients were examined, treated, and administered the ocular surface disease index (OSDI) survey every 4–6 weeks for four total treatments. Tear film and conjunctival samples were collected at first and last visits, and analyzed for TGF-β concentration and 16s rRNA amplicon sequencing of ocular microbiome. Wilcoxon Rank Sum and Sign-Rank were used to examine changes from baseline. Results OSDI revealed significantly greater improvement in symptoms after IPL-MGX (p=0.030) compared to MGX. There was no significant difference in mean TGF-β1, 2, or 3 concentration after IPL-MGX (p=0.385, 0.709, 0.948, respectively). Quantities of Clostridium, Klebsiella, Brevibacterium, Lactobacillus, Neisseria, Streptococcus, Corynebacterium, Butyricicoccus, and Actinomyces were significantly reduced from baseline in both groups but without a significant difference between the two treatment groups. Conclusion IPL-MGX improved dry eye symptoms more than MGX alone. IPL treatment offered no additional benefit to MGX in decreasing virulent bacteria present on the ocular surface and did not influence TGF-β levels in tears. Prospective studies on IPL-MGX with larger sample sizes are needed to further investigate cytokines and IPL in patients suffering from ocular rosacea with dry eye symptoms. ClinicalTrials.gov Identifier NCT03194698., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/HXqU-Nz8S3A

Die okulare Rosazea im Kindesalter ist eine seltene, aber oft unterdiagnostizierte Erkrankung. Chronische Blepharokonjunktivitis, Chalazien, Hornhauttrubungen und -neovaskularisationen sind typische Befunde. Die empfohlene Therapie besteht aus topischen (Lidhygiene, Steroide, Ciclosporin, Benetzungsmittel) und systemischen (Antibiotika, z. B. Erythromycin) Masnahmen. Unsere Fallserie von 8 Kindern belegt die Wirksamkeit der lokalen 1,5 % Azithromycin-Therapie kombiniert mit Lidhygiene bei kindlicher okularer Rosazea. Ein weiterer Vorteil dieser topischen Therapie ist, dass sie nur 2‑mal taglich uber 3 Tage mit anschliesender Pause von 7 Tagen angewendet werden muss. Dies verbessert auch die Therapietreue.

Kuo-Hsuan Hung,1– 3 Yu-Hsiang Lan,2,4 Jui-Yen Lin,1,2 Eugene Yu-Chuan Kang,1,2 Hsin-Yuan Tan,1,2 Hung-Chi Chen,1,2 Ching-Hsi Hsiao,1,2 Lung-Kun Yeh1,2 1Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan; 2Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan; 3Institute of Clinical Medicine, National Yang-Ming University, Taipei City 112, Taiwan; 4Department of Medicine, Chang Gung University, Taoyuan 333, TaiwanCorrespondence: Lung-Kun YehDepartment of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No 5, Fusing St., Taoyuan 333, TaiwanTel +886-3-3281200, ext. 8666Fax +886-3-3287798Email yehlungkun@gmail.comPurpose: To evaluate the role of Demodex infestation of the eyelids in patients with recurrent herpetic keratitis.Patients and Methods: This is a retrospective and noncomparative case series. Twenty-seven patients with ocular demodicosis and recurrent herpetic keratitis under conventional treatments were enrolled. Demographic data and clinical photographs were collected. Ocular demodicosis was confirmed by eyelash examination under a microscope. Eyelid scrub was initiated in these patients after proving Demodex infestation. Response after treatment was reviewed.Results: Herpetic keratitis was characterized by epithelial defect, including dendritic lesions (seven eyes, 25.9%), geographic ulcer (three eyes, 11.1%), and neurotrophic ulcer (two eyes, 7.4%), associated with stromal involvement in 12 cases. Six cases with stromal reactivation, including disciform keratitis (two eyes, 7.4%), immune ring (three eyes, 11.1%), and ghost vessel (one eye, 3.7%), presented no epithelial defect. Active anterior uveitis with keratic precipitates was found in 15 cases. Demodex blepharitis was diagnosed with cylindrical dandruff along their lashes in all patients. Other ocular findings include meibomian gland dysfunction (15 eyes, 55.6%), mal-aligned lashes (eight eyes, 29.6%), telangiectasia (14 eyes, 51.9%), conjunctivitis (18 eyes, 66.7%), and ocular rosacea (three eyes, 11.1%). Initial unstable clinical presentations showed deterioration of corneal melting into descemetocele, corneal perforation, recalcitrant stromal infiltration/uveitis, and uncontrollable IOP, despite antiherpetic medication. After treatment of Demodex blepharitis, infestation was under control, followed by subjective improvement of ocular symptoms and a stable clinical outcome.Conclusion: Ocular demodicosis should be considered in patients with unstable recurrent herpetic keratitis. A prompt diagnosis and appropriate treatment may curb the progression of herpetic corneal infection.Keywords: blepharitis, Demodex mites, herpetic keratitis, ocular demodicosis

Among the temporary skin ecto-parasites, Demodex folliculorum is a worm-like mite that infests hairfollicles in various mammals including man. Rosacea is a common skin disorder that may occur inadults of all ethnic backgrounds, but is most commonly diagnosed in individuals with fair skin. Ocularrosacea may present independently or in association with cutaneous subtypes of rosacea. This studyclarified the correlation between ocular rosacea and demodicosis folliculorum in family patients; twofemales of them were superimposed with secondary bacterial infection. The patients acquired in zoonoticinfestation from their pet dog. The pet dog was sent to the Governmental Veterinary Hospital atAbbassia and was treated with Ivermectin®.Specific ocular infections often required etiological diagnosis of combined consultant ophthalmologyand microbiology

Corneal neovascularization (CNV) has a variety of causes and threatens corneal clarity, thus optimal visual acuity. Conventional medical management includes topical steroids and matrix metalloproteinase inhibitors like doxycycline. Anti-vascular endothelial growth factor (anti-VEGF) agents have demonstrated promise but remain off-label for this indication. However, these agents hold value in cases refractory to first-line medical management. We report the case of a 63-year-old woman who presented with ocular rosacea and CNV affecting vision, on a background of acne rosacea. She was initially treated with fluorometholone and doxycycline, yet continued to deteriorate. Eventually she received two 1.5-mg subconjunctival injections of bevacizumab 2 months apart. CNV completely resolved and results were maintained at 4-year follow-up. This case demonstrates that refractory CNV can be effectively treated with subconjunctival injection of anti-VEGF bevacizumab. The resolution of CNV was also maintained years after injection with minimal adjunctive therapy during this period, and to our knowledge there are no other studies reporting a follow-up period of 4 years after treatment. This is a pertinent case for other clinicians treating patients in a similar situation.

La rosácea es una alteración cutánea crónica que se ha asociado con factores etiológicos inespecíficos y diversas manifestaciones sistémicas. La rosácea cutánea suele evolucionar a rosácea ocular del 6 al 72 % de los pacientes. Al no existir criterios específicos que la caractericen, la rosácea ocular implica un reto diagnóstico. Para fortalecer la sospecha diagnóstica temprana, se presentan tres casos de pacientes con evolución clínica distinta, pero que tuvieron en común el retraso diagnóstico, lo que se tradujo en manifestaciones graves y daño ocular extenso.

Objective: To directly observe the in vitro real-time effects of intense pulsed light (IPL) on a Demodex mite extracted from an eyelash of a patient with ocular rosacea. Background: Demodex is a ri...

Introduction: Rosacea is a chronic cutaneous disorder with non specific and variable ocular manifestations. Ocular rosacea is often underdiagnosed, despite the potential for serious sight threatening sequelae. Aim: The study was designed to determine the incidence of ocular disease among the population of rosacea patients along with evaluating the presence of eye dryness in both the patients and controls using Schirmer 1 test. It correlated the severity of ocular disease with the severity of cutaneous rosacea. Materials and Methods: A total of 72 patients with facial rosacea were enrolled and evaluated with thorough history, physical and ophthalmological examination for ocular rosacea. Schirmer’s test was performed on all patients with ocular rosacea and controls. Results: Out of 72 patients with facial rosacea, 30 (41.62%) were diagnosed with ocular rosacea. On the Schirmer test, ocular rosacea patients had statistically significant lower value than the control group. There was also a statistically significant difference between mean Schirmer test values of male patients and controls and female patients and controls. Conclusion: Symptoms of ocular rosacea are not always specific hence underdiagnosed. Ocular features of rosacea in patients presenting with mere cutaneous findings should not be overlooked. Keywords: Ocular, Rosacea, Schirmer’s test.

Background Rosacea is a common chronic inflammatory cutaneous disorder affecting nearly 5.5 % of the adult population. Our aim was to evaluate the prevalence and epidemiology of rosacea and perioral dermatitis (POD) in an ambulatory care setting. Methods We retrospectively analyzed medical data of patients with a confirmed diagnosis of rosacea or perioral dermatitis (POD) presenting at our university hospital outpatient clinic during a 3‐year period. Results Out of 1032 patients, 81.5 % were diagnosed with rosacea and 18.5 % with POD. Overall prevalence was 1.4 % for rosacea and 0.3 % for POD. 69.3 % of the analyzed patients were female. Overall mean age was 49.3 ± 7.7 (1–92) years; the women’s average age was less than the men’s. Patients with POD were younger and predominantly female, whereas patients with phymatous rosacea were older and predominantly male. The most common phenotypes were papulopustular rosacea (68.4 %), erythematotelangiectatic rosacea (22.5 %), and phymatous rosacea (8.0 %). Special forms of rosacea were diagnosed in 15.8 % of the patients; the most frequent were ocular rosacea (6.9 %) and steroid‐induced rosacea (5.4 %). Conclusions The large patient cohort analyzed in our study provides a good estimate of the frequency of the rosacea subtypes, special forms and of perioral dermatitis in a hospital‐based outpatient care setting.

Purpose: To investigate the efficacy of once-daily topical treatment of ocular and cutaneous rosacea with ivermectin 1% cream (Soolantra®, Galderma).Methods: Ten patients with rosacea were evaluate...

Introduction Ocular rosacea is a multifactorial disease. Its pathophysiology remains unclear. The ocular manifestations of rosacea are not specific and can range from simple blepharoconjunctivitis to sight-threatening such as corneal perforation. Case report We report the case of a 10-year-old child who presented with a red painful right eye. Based on the clinical findings, we concluded that she had a corneal perforation on ocular rosacea. She benefited from an ipsilateral lamellar autokeratoplasty by lamellar autograft. The evolution was marked by a good healing and a good visual recovery despite a corneal scar. Discussion Ocular rosacea is a multifactorial disease, with an unclear physiopathology. Corneal involvement remains the least common, but the most challenging since serious complications can occur. Corneal perforation is the most severe. Several techniques have been reported and used in the management of corneal perforations such as conjunctival flap, amniotic membrane grafting, and the use of a corneal patch. The later, corneal autografting, remains a simple and effective technique with satisfactory anatomical results. Conclusion Ocular rosacea is a pathology that is still poorly understood and of delayed diagnosis. It can lead to serious vision-threatening complications such as corneal perforation. The corneal patch is a simple, effective and efficient technique that has given good results in our case., Highlights • Ocular rosacea is a multifactorial disease • Various clinical presentation ranging from blepharitis to severe and sight threatening such as corneal perforation • Surgical treatment: ipsilateral lamellar autokeratoplasty

Purpose To report a successful treatment of chronic rosacea associated ocular demodicosis with lid scrub containing terpinen-4-ol (T4O). Observations A 72-year old woman presented with recurrent and refractory ocular erythema, irritation, dryness, and photophobia despite conventional medical treatment (artificial tears, hypochlorous acid lid hygiene, doxycycline, and erythromycin) for 5 years. Examination revealed facial erythema, telangiectasias on cheeks, nose and lids, and cylindrical dandruff (CD) on bilateral upper and lower lashes. Epilation sampling confirmed demodicosis. After treatment with lid wipe containing T4O (Cliradex, Biotissue, Miami, FL) over face and lids, ocular discomfort, CD, facial and eyelid erythema, telangiectatic vessels were significantly reduced. Complete eradication of demodex mites and resolution of symptoms and signs lasted 8 months of follow-up. Conclusions This case suggests that T4O is effective in treating chronic rosacea associated ocular demodex blepharitis.

Spectral-domain optical coherence tomography (SD-OCT) has been used to observe the morphology of the palisades of Vogt (POV) with satisfactory resolutions. In this study, we used SD-OCT to examine the microstructure of the POV in ocular surface disorders with limbal involvement. We detect subclinical limbal pathologies based on five parameters, including (1) decreased epithelial thickness, (2) loss of the sharp stromal tip, (3) loss of the smooth epithelial-stromal interface, (4) dilated stromal vessels, and (5) decreased POV density. Eighteen eyes of 10 patients with advancing wavelike epitheliopathy (AWE) and 15 eyes of 9 patients with phlyctenular keratitis/ocular rosacea were recruited. SD-OCT could detect abnormal changes in the POV in 100% of the lesion sites. In presumed-healthy areas of the diseased eyes diagnosed by slit-lamp biomicroscopy, SD-OCT detected abnormal changes in the POV in 100% of the eyes in both groups. In patients with unilateral disease, abnormal changes in the POV were detected by SD-OCT in 50% and 100% of presumed-healthy eyes diagnosed by slit-lamp biomicroscopy in the AWE group and phlyctenular keratitis/ocular rosacea group, respectively. SD-OCT is powerful in detecting POV changes in ocular surface disorders and can provide useful information that cannot be provided by slit-lamp biomicroscopy.

Purpose: To report a case of ocular rosacea with corneal infiltrates and vascularisation. Here we report a case of a 34-year-old male presenting with ocular rosacea with corneal infiltrates and vascularisation in the left eye with posterior blepharitis of both eyes. The clinical diagnosis was based on the facial findings of erythematous papulomacular lesions and telangiectasia. The patient was treated with systemic doxycycline and for ocular lesions treated with antibiotic steroids and lubricants. Ocular rosacea, if not treated on time, can worsen to the stage of corneal infiltrates and vascularisation.

espanolObjetivo: describir la rosacea ocular, con el fin de guiar un acertado diagnostico y tratamiento.Materiales y metodos: se realizo una busqueda sistematica de articulos de revision disponiblesen texto completo, en bases de datos como PubMed, Ebsco Host, Proquest, Medline, Elsevier,Scielo y Springer, asi como textos literarios relacionados con el tema, escritos en ingles, espanol,aleman, frances y portugues. Se implemento una estrategia de busqueda con palabras como “rosaceaocular”, “manejo y fisiopatologia de la rosacea”, “ojo seco”, “disfuncion de glandulas demeibomio” y “Demodex”. Se seleccionaron escritos con un periodo de publicacion comprendidoentre el 2000 y el 2015. Conclusion: el manejo de la enfermedad esta direccionado al control designos y sintomas mediante la aplicacion de medidas conservadoras, terapia sistemica, aplicaciontopica ocular, y en casos avanzados se opta por la intervencion quirurgica. Todo lo anteriorpermite afirmar que el objetivo principal de los profesionales de la salud visual es minimizar eldano ocular mediante la prevencion de complicaciones futuras. EnglishObjective: To describe ocular rosacea, in order to guide an accurate diagnosis and treatment.Materials and methods: A systematic search of full-text review articles was carried out indatabases such as PubMed, Ebsco Host Proquest, Medline, Elsevier, Scielo, and Springer,as well as literary texts related to the topic, written in English, Spanish, German, French,and Portuguese. A search strategy was implemented using keywords such as “ocular rosacea,”“management and pathophysiology of rosacea,” “dry eye,” “dysfunction of meibomianglands,” and “Demodex.” Studies were selected from a publication period between 2000and 2015. Conclusion: The management of this disease is aimed to control signs and symptomsthrough the application of conservative measures, systemic therapy, topical ocularapplication; in advanced cases, surgical intervention is chosen. All the above allows affirmingthat the main objective of visual health professionals is to minimize ocular damageby preventing future complications.

Background: Rosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping. Objectives: To update our systematic review on interventions for rosacea. Methods: We searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index and ongoing trials registers (March 2018) for randomized controlled trials. Study selection, data extraction, risk-of-bias assessment and analyses were carried out independently by two authors. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess certainty of evidence. Results: We included 152 studies (46 were new), comprising 20 944 participants. Topical interventions included brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light-based treatment. We present the most current evidence for rosacea management based on a phenotype-led approach. Conclusions: For reducing temporarily persistent erythema there was high-certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia there was low-to-moderate-certainty evidence for laser and intense pulsed light therapy. For reducing papules/pustules there was high-certainty evidence for topical azelaic acid and topical ivermectin; moderate-to-high-certainty evidence for doxycycline 40 mg modified release (MR) and isotretinoin; and moderate-certainty evidence for topical metronidazole, and topical minocycline and oral minocycline being equally effective as doxycycline 40 mg MR. There was low-certainty evidence for tetracycline and low-dose minocycline. For ocular rosacea, there was moderate-certainty evidence that oral omega-3 fatty acids were effective and low-certainty evidence for ciclosporin ophthalmic emulsion and doxycycline.

Background Rosacea is a highly prevalent, chronic inflammatory disease. The treatment of rosacea remains a challenge to dermatologists. Therapies include skin care, medications, lasers, and various combinations of these modalities. The appropriate treatment depends on clinical types and patient's various clinical symptoms. Purpose The purpose of this study was to review and compare current therapies for rosacea of all severities from four different guidelines. Methodology We searched PubMed using the keywords "rosacea," "treatment" AND ["erythema rosacea" OR "papulopustular rosacea" OR "ocular rosacea" OR "phymatous rosacea"]. We selected randomized controlled trials, observational studies, controlled clinical trials, and clinical trials. We indentified further studies (including the guidelines) by hand-searching relevant publications and included those that met the inclusion criteria. Results The total number of records identified was 421. We limited our search to the specific abovementioned study types. Twenty-five of these studies met with our inclusion criteria. An additional five manuscripts were selected using the abovementioned method, and four guidelines were included in this review. Conclusion Diagnosing and choosing the appropriate treatment options of rosacea according to guidelines is the basis of scientific criteria. More large-scale randomized controlled clinical trials on new treatment methods, new drugs, or new dosage forms provide a new guideline for future rosacea treatment. Although there are some differences in the treatment of rosacea, it is generally based on anti-demodex, anti-inflammatory, and anti-angiogenesis.

Background: Current knowledge about ocular rosacea in dark skin individuals is lacking. The prevalence of ocular rosacea varies considerably among studies and is probably higher than previously presumed. Objective: To estimate the prevalence and pattern of ocular rosacea among dark skinned female patients, compare it with fair skinned, and to correlate the severity of cutaneous disease with ocular findings. Method: Female patients diagnosed with rosacea between 2011 and 2013 were studied prospectively. They were referred to ophthalmology for clinical observations and slit lamp examination. In all patients Schirmer and Tear break up time tests to diagnose dry eye were performed. Result: Fifty six consecutive female patients, joined the study with different skin types ranging from skin type 4 to 6. A total of 43 patients (76.8%) were positive for ophthalmologic findings. The most frequent symptoms were itching, burning sensation and redness, while the most frequent signs were meibomian gland dysfunction, dry eyes, eyelid telangiectasia and irregular margin. Significant correlation was noted between meibomian gland dysfunction and irregular lid margin (P = 0.003). Dry eye and Schirmer test significantly correlated with eye lid telangiectasia (p = 0.004; 0.015) respectively. No significant correlation was found between the severity of cutaneous disease and ocular findings. Conclusion: Ocular rosacea in dark skinned females is a common presentation and is comparable to that reported for fair skin, with eyelid telangiectasia and meibomian gland dysfunction being early phenomena. Earlier onset and more benign course were seen compared to other studies. Ocular and cutaneous rosacea are independent of each other. Keywords: Dark skin, Ocular rosacea, Dry eye

Objective: to evaluate the clinical efficiency of eyelid cryotherapy with an autonomous titanium nicke lide cryoapplicator in patients with ocular rosacea regarding the dynamics of pro- and anti-inflammatory cytokines contents at local levels. Materials and methods. 65 patients with ocular rosacea were observed. Depending on the therapy received, the patients were divided into two groups: in the main group, eyelid cryotherapy was applied for 2 weeks with an autonomous cryoapplicator made of porous-permeable titanium nickelide, and in the reference group, the patients received a traditional treatment for a month. The contents of cytokines (IL-1, IL-8, IFN-, IL-2, IL-10) in lachrymal fluid was evaluated by ELISA on Days 3, 7 and 30 after treatment. Results. The opposite nature of cytokine balance changes and the ratio of its pro- and anti-inflammatory link during the follow-up period were revealed. A reliable dynamic increase of examined IFN- and IL2 content in the lacrimal fluid after cryostimulation can evidence for an adequate activation of cellular immunity link, as well as for enhancement of regeneration mechanisms. Conclusion. The analysis of obtained data evidences for a high efficiency of clinical and immunological effect of lid cryotherapy using titanium nickelide cryoprobe for ocular rosacea treatment.

Objective: To investigate changes in corneal endothelial cell density, corneal morphology and central corneal thickness in patients with ocular rosacea. Method: 60 eyes of 30 ocular rosacea patients and 60 eyes of 30 control group with similar demographic characteristics were included in the study. Detailed ophthalmological examination was performed in all individuals participating in the study. The eyes of all participants were evaluated by specular microscopy, schirmer 1 test, tear break-up time test (TBUT). Additionally, via specular microscopy the following parameters were assessed: endothelial cell density (ECD), mean cell area (ACA), minimum cell area (CAmin), maximum cell area (CA max), cell area standard deviation (SD), coefficient of variation in the cell area (CV), hexogonal cell ratio (HEX), central corneal thickness (CCT) numerical (NUM). Results: Although none of the differences are statistically significant, patients with ocular rosacea have lower ACA, CA min, CA max, HEX, CCT and NUM values (p = 0,169, p = 0,897, p = 0,694, p = 0,649, p = 0,164 and p = 0,070, respectively), and higher CD, SD and CV values (p = 0.509, p = 0.437, p = 0.165, respectively). In ocular rosacea patients, there was no significant correlation was found the values of mean Schirmer test between CV, HEX, ECD, CT (p = 0.394, p = 0.906, p = 0.222, p = 0.208, respectively). Additionally, no significant correlation was found between tear break-up time and CV, HEX, ECD, CCT (p = 0.079, p = 0.227, p = 0.621, p = 0.712, respectively). Conclusions: Our finding show that, despite the presence of some observable differences, corneal endothelial functions are similar to control group in patients with ocular rosacea.

The use of silver preparations in medicine is becoming increasingly popular. The basic aim of this evaluation was to review the literature on the clinical (in vivo) and antibacterial potential of silver preparations in ophthalmic diseases. The second goal was to summarize the results of experimental research on the use of silver preparations in ophthalmology. The third objective was to present a method for stabilizing eye drops containing silver (I) complex. Analysis of the pH stability of the silver (I) complex with metronidazole in the prepared dosage form (eye drops) was carried out. Most silver preparations are clinically used for topical application. Few experimental results indicate the usefulness of intraocular or systemic administration of silver (I) preparations as an alternative or additional therapy in infectious and angiogenic eye diseases. The development of a new formulation increases the stability of the dosage form. New forms of silver (I) products will certainly find application in the treatment of many ophthalmic diseases. One of the most important features of the silver (I) complex is its capacity to break down bacterial resistance. The new eye drops formula can significantly improve comfort of use. Due to their chemical nature, silver (I) compounds are difficult to stabilize, especially in the finished dosage form.

Ocular rosacea is a chronic inflammatory condition that can occur in the absence of cutaneous features. The most common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring and, rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. It can also be associated with systemic disorders such as cardiovascular disease. Management ranges from local therapy to systemic treatment, depending on the severity of the disease. In this review, we describe the epidemiology, pathophysiology, clinical features and treatment of rosacea and ocular rosacea.

Rosacea is a chronic inflammatory condition that affects the skin and the eyes. The pathogenesis of rosacea is complex and includes the interaction between genetic and environmental factors, dysregulation of the innate immune system, neurovascular modifications and the interaction with skin commensals. Clinical manifestations in children include the telangiectatic form, papulopustular rosacea, ocular rosacea, periorificial dermatitis, granulomatous rosacea and idiopathic facial aseptic granuloma. Management is aimed at identifying and avoiding triggers. Topical therapy is used for mild cases with topical antibiotics and anti-inflammatory agents. Oral agents are indicated, in combination with topical therapy, for moderate to severe cases. Prolonged therapy may be required.

Purpose: Rosacea is one of the most common conditions affecting the ocular surface. The purpose of this review is to provide an update on the pathogenesis and treatment of rosacea based on the dermatology and ophthalmology literatures. Methods: Literature searches were conducted for rosacea and ocular rosacea. Preference was given to systematic reviews, meta-analysis, case-controlled studies, and documented case reports while excluding poorly documented case studies and commentaries. The data were examined and independently analyzed by more than two of the authors. Results: Rosacea is a complex inflammatory condition involving the pilosebaceous unit. Its underlying mechanism involves an interplay of the microbiome, innate immunity, adaptive immunity, environmental triggers, and neurovascular sensitivity. The latest classification of rosacea includes three dermatologic subgroups and a fourth subgroup, ocular rosacea. Ocular rosacea clinically displays many features that are analogous to the cutaneous disease, such as lid margin telangiectasia and phlyctenulosis. The role of environmental triggers in the exacerbation of ocular rosacea appears to be understudied. While lid hygiene and systemic treatment with tetracycline drugs remain the mainstay of treatment for ocular rosacea, newer dermatologic targets and therapies may have potential application for the eye disease. Conclusions: Ocular rosacea appears to embody many of the manifestation of the dermatologic disease. Hence, the basic pathophysiologic mechanisms of the ocular and cutaneous disease are likely to be shared. Better understanding of the ocular surface microbiome and the immunologic mechanisms, may lead to novel approaches in the management of ocular rosacea.

Rosacea is a chronic inflammatory cutaneous disorder affecting the facial convexities including the cheeks, chin, forehead, and nose. While most commonly associated with facial rash and flushing, the majority of patients with rosacea have ocular involvement, which may even precede other facial symptoms. Ocular rosacea can result in foreign body sensation, dryness, tearing, and light sensitivity arising from eyelid inflammation, including meibomian gland dysfunction, and ocular surface inflammation. Given the current lack of definitive therapy, treatment of ocular rosacea focuses on symptom management and limiting complications. The mainstay of therapy involves aggressive lubrication with artificial tears and ointment with regular use of warm compresses to improve meibomian gland dysfunction. Lifestyle modification and dietary supplementation with omega-3 fatty acids may also play a role. For those patients with persistent symptoms, topical cyclosporine serves as an effective immunomodulator and mitigates the inflammatory response as do topical antibiotics (e.g., macrolides). Oral antibiotics, such as tetracyclines, serve to limit inflammation by targeting matrix metallopeptidases and improve signs and symptoms of the disease. Other common treatments for meibomian gland dysfunction including oral azithromycin have also been shown to be effective in the treatment of ocular rosacea. While the majority of these therapies are well-tolerated, adverse effects can range from relatively benign discomfort during instillation of eyedrops to significant complications in pregnancy. With continued research revealing the interdependence between genetic predisposition, the immune response, and autonomic and vascular dysregulation, multiple new targets for therapy have been identified, which bring with them the potential for more effective and specific therapies.

Rosacea is a syndrome and not a pathogenically defined disease. Currently, there is no well-established basic mechanism of disease established for rosacea. The classification of rosacea began with the distinction from acne, and by the last half of the twentieth century, the classifications of experts in different countries had become aligned around the notion of rosacea having four or more phenotypic subtypes with some versions allowing for possible, but not obligatory, progression of these phenotypic subtypes as “stages.” While these classifications from different authors consistently recognized similar phenotypic subtypes, there were differences in their precise definitions. In 2002 a consensus committee of the National Rosacea Society (NRS) sought to develop definitions which would provide for a more standardized classification system. These four classic phenotypic subtypes of rosacea have important utilities, including the increased awareness that use of products demonstrated to improve only papulopustular rosacea may lead to disappointment in physicians and their patients with only erythematotelangiectatic rosacea.

Purpose: To report a case series of seven eyes (six patients) with severe limbal stem cell failure who underwent cultivated oral mucosa epithelium transplantation (COMET) in preparation for corneal transplant surgery and assess the change in visual acuity postoperatively. Design: Case series. Methods: A retrospective analysis of an interventional case series of six patients with severe limbal stem cell deficiency who underwent COMET between 2012 and 2015 was performed. Six eyes had COMET followed by corneal transplant, and one eye had corneal transplant preceding COMET. The change in the visual acuity after operation was evaluated. Results: A total of six patients with seven eyes were studied. All of them had severe ocular surface disease with limbal stem cell deficiency (LSCD) secondary to chemical injury (five eyes), SJS (one eye), and severe ocular rosacea (one eye). Four eyes had improvements in visual acuity, two of which achieved best corrected visual acuity (BCVA) of 6/12. Conclusion: The use of COMET helps to optimize the ocular surface in severe LSCD for further corneal transplant surgeries. It has helped to improve the graft uptake and subsequent visual improvement, especially in chronic chemical burn cases.

Background Metronidazole with well-soluble silver nitrate forms a complex with potent activity (synergism) against bacterial strains and fungi with simultaneous lower side effect than in the case of the two agents administered separately. This study aimed to establish effectiveness in the treatment of ocular rosacea with new formulation of drops and ointment with silver(I) complex of metronidazole. Methods Three patients suffering from serious ophthalmic complications of acne rosacea were treated with drops and ointments applied 3 times a day for 3 months. The uncorrected visual acuity testing (UCVA), pachymetry as well as subjective and objective tear film assessment were evaluated. Results In all patients, we have improved UCVA as well as objective and subjective evaluation of the tear film parameters. No significant differences in corneal thickness were observed. Conclusion Well soluble silver(I) complex of metronidazole might be an alternative method in ophthalmic complications of acne rosacea treatment.

Background Many articles in rosacea have been published. Bibliometric analysis is helpful to determine the most influential studies in a specific field. Objective To identify the top 100 most cited articles in rosacea using the bibliometric analysis method. Methods We searched in the Web of Science database on 20 November 2019. Articles were listed in descending order by their total citations. The top 100 most cited articles in rosacea were identified and analysed. Results The top 100 most cited articles were published between 1971 and 2015. The largest number of articles was published in a single interval in 2011-2015. The average annual citations were constantly ascending, and the total citations were positively correlated with annual citations. The 100 articles were classified into different research focuses: treatment (35%), pathogenesis (27%), clinical features and diagnosis (14%), pathophysiology (6%), associated diseases (4%), epidemiology (3%) and others (11%). A total of 19 articles were randomized controlled trials (RCT), 14 focused on the association between rosacea and Demodex, and five focused on the association between rosacea and Helicobacter pylori. Twenty-five publications focused on a specific subtype of rosacea, mainly papulopustular and ocular rosacea. The 100 articles were published in 32 journals. A total of 79 different first corresponding authors were from 20 different countries, mostly in North America and Europe. Steinhoff. M from University of California published the most articles as the corresponding author. Conclusions This study identified the top 100 most cited articles in rosacea and analysed their bibliometric characteristics, which may pave the way for further research.

Demodex folliculorum and Demodex brevis are two mites which infest the human eye and which may, in excess, lead to a wide range of anterior segment findings. Demodex mites have been implicated in anterior and posterior blepharitis, blepharoconjunctivitis, blepharokeratitis, and beyond. Due to significant overlap with other anterior segment conditions, Demodex infestation remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash sampling, and the most common mode of treatment is with tea tree oil in varying concentrations. This article summarizes elements of pathogenesis, diagnosis, and management critical to clinical care of this common condition.

The lack of validated rosacea assessment tools is a hurdle in assessing rosacea severity. This article discusses a valid and reliable rosacea severity self-assessment tool (RSAT) to measure rosacea severity. To determine test-retest validity, participants completed the self-assessment twice. A blinded physician graded the participant's disease severity with the Investigator Global Severity (IGS) score. Pearson correlations were used to assess the relationship between the self-assessment measure and the IGS. Test-retest RSAT measurements were correlated. The RSAT represents a valid and reliable tool. This tool may facilitate determination of rosacea severity in survey research studies.

Aims: The purpose of this paper was to determine the lacrimal concentration of IL-1α and MMP-9 in patients with active ocular rosacea before and after systemic treatment with azithromycin or doxycycline. Methods: After 4 weeks of therapy with azithromycin (500 mg/day, 3 days a week PO) or doxycycline (200 mg/day PO), lacrimal samples were analyzed using an enzyme-linked immunosorbent assay multiplex. Results: There was a significant difference between baseline IL-1α (37.9 pg/mL) and MMP-9 (26.7 ng/mL) in rosacea eyes compared to controls (0.001 pg/mL for IL-1α and 0.2 ng/mL for MMP-9) (p < 0.001). IL-1α decreased from 47.0 pg/mL before azithromycin to 23.5 pg/mL after treatment (p = 0.024), but not after doxycycline therapy. On the contrary, baseline MMP-9 tear levels (10.28 ng/mL) decreased after treatment (8.36 pg/mL) with doxycycline (p = 0.054) but not with azithromycin. There was a strong clinical correlation of higher baseline IL-1α tear levels between patients who responded to doxycycline therapy and those who failed (p = 0.043). Patients unresponsive to azithromycin had significantly higher baseline MMP-9 levels than those with doxycycline (p = 0.040). Conclusions: While IL-1α levels decreased after azithromycin therapy, MMP-9 did so after doxycycline treatment. Baseline cytokine tear levels tend to be markedly elevated in patients with antibiotic failure, suggesting their potential role as therapeutic biomarkers for the disease.

Childhood rosacea presents a diagnostic difficulty due to the lack of diagnostic criteria and potential mimics. Ocular involvement is a frequent complication of rosacea in children and may appear before cutaneous findings. It is important for clinicians to be aware of these and to screen patients appropriately in order for timely treatment to be instituted.

Introduction: Cornea clarity is essential for optimal vision at any age. In childhood, loss of corneal transparency may also lead to amblyopia. Thus, proper management of the conditions that lead t...

This literature review examines principal aspects of rosacea prevalence in the Russian Federation and abroad, shows present-day opinions about the pathogenesis and histological picture of rosacea and presents actual classification and a number of key clinical forms of the disease.

SummaryBackground Rosacea is currently treated according to subtypes. As this does not adequately address the spectrum of clinical presentation (phenotypes), it has implications for patient management. The ROSacea COnsensus panel was established to address this issue. Objectives To incorporate current best treatment evidence with clinical experience from an international expert panel and establish consensus to improve outcomes for patients with rosacea. Methods Seventeen dermatologists and three ophthalmologists reached consensus on critical aspects of rosacea treatment and management using a modified Delphi approach. The panel voted on statements using the responses ‘strongly disagree’, ‘disagree’, ‘agree’ or ‘strongly agree’. Consensus was defined as ≥ 75% ‘agree’ or ‘strongly agree’. All voting was electronic and blinded. Results The panel agreed on phenotype-based treatments for signs and symptoms presenting in individuals with rosacea. First-line treatments were identified for individual major features of transient and persistent erythema, inflammatory papules/pustules, telangiectasia and phyma, underpinned by general skincare measures. Multiple features in an individual patient can be simultaneously treated with multiple agents. If treatment is inadequate given appropriate duration, another first-line option or the addition of another first-line agent should be considered. Maintenance treatment depends on treatment modality and patient preferences. Ophthalmological referral for all but the mildest ocular features should be considered. Lid hygiene and artificial tears in addition to medications are used to treat ocular rosacea. Conclusions Rosacea diagnosis and treatment should be based on clinical presentation. Consensus was achieved to support this approach for rosacea treatment strategies.

Rosacea is a chronic skin disease characterized by erythema, telangiectasia, papules and pustules in the central facial region. It most often affects adults and is rare in children. Rosacea can also present ocular involvement. Symptoms can precede cutaneous findings, appear simultaneously or after them, with a higher risk of ocular complications in children. Because of low prevalence of rosacea in childhood, the diagnosis is frequently delayed. We report a 1-year-old boy with ocular and cutaneous rosacea who developed corneal opacities and visual impairment. Early diagnosis and treatment is considerable to avoid sequels.

Rosacea is a chronic cutaneous disorder which is known to cause inflammation and increased proteolytic activity on the ocular surface that might lead to corneal biomechanical alterations. The aim of this study is to evaluate the corneal biomechanical properties of ocular rosacea patients and compare the measurements with healthy individuals as measured with Reichert ocular response analyser (ORA). Besides full eye examination [best corrected visual acuity (BCVA), intraocular pressure (IOP) measured with Goldmann applanation tonometry (IOP-G)], central corneal thickness (CCT), and ORA [corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated IOP (IOPcc), Goldmann correlated IOP (IOPg)] measurements of 30 eyes of 15 ocular rosacea patients (study group) and 30 eyes of 15 healthy individuals (control group) were performed. For comparisons paired t test was used. Mean age of study group was 45.26 ± 11.65 (range 25 and 63) and control group was 45.00 ± 8.91 (range 26 and 58) years (p = 0.865). No significant difference in BCVA, CCT, IOP-G, IOPcc was detected among groups. However, IOPg, CH, and CRF in the study group were significantly lower than in the control group (p = 0.013, p = 0.013, p = 0.009, respectively). IOPg, CH, and CRF parameters of ocular rosacea patients were significantly lower than normal individuals. These differences and their probable clinical reflections that might effect making decisions in conditions such as glaucoma should be investigated in larger number of patients.

Although the number of dermatologic conditions with ocular manifestations is relatively limited, these entities have a high prevalence and represent a large proportion of clinic visits to both dermatologic and ophthalmic practices. This contribution will review oculocutaneous diseases that are not part of the allergic or autoantibody-mediated spectrum.

A 68-year-old man presented with a 3-year history of red eye and sudden intensive gritty and burning sensations in his left eye after angle-supported anterior chamber intraocular lens (AC IOL) implantation. Examination revealed exposure of the AC IOL haptic tip through the interior corneal limbus. The patient had had ocular rosacea for many years but had not experienced any trauma since the AC IOL implantation. Anterior chamber IOL explantation, anterior pars plana vitrectomy, and posterior chamber suspended IOL implantation were performed to restore visual acuity; topical antibiotic and corticosteroid treatments were administered for the ocular rosacea. Surgical interventions were required to prevent ocular complications such as corneal endothelial decompensation and endophthalmitis. To our knowledge, spontaneous haptic tip exposure is rare in patients with AC IOL implantation. In this case, it might have been due to chronic inflammation caused by ocular rosacea. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Objectives: To report the clinical features, treatment options and complications in patients with ocular rosacea. Materials and Methods: The records of 48 eyes of 24 patients with ocular rosacea were retrospectively reviewed. Patients’ ocular signs and symptoms were scored between 1 and 4 points according to disease severity; tear film break-up time (BUT) and Schirmer’s test results were recorded before and after the treatment. Preservative-free artificial tears, topical antibiotic eye drops/ointments, short-term topical corticosteroids, topical 0.05% cyclosporine and oral doxycycline treatment were applied as a standard therapy to all patients. Additional treatments were given as needed. Complications were recorded. Results: Twenty-four patients with a mean age of 48.5±35.4 (32-54) years were followed for a mean 15±9.4 (8-36) months. Ocular findings included meibomitis in 100% of cases, anterior blepharitis in 83% (40 eyes), punctate keratopathy in 67% (32 eyes), chalazia in 50% (24 eyes), corneal neovascularization in 50% (24 eyes) and subepithelial infiltrates in 16.6% (8 eyes). Significant improvement of symptoms and clinical findings were achieved in all patients with treatment. The increases in Schirmer’s test and BUT were 3.3±1.5 and 4.5±2.8, respectively (p

Rosacea is a common chronic inflammatory disease, especially in patients with fair skin and positive family history. Typical locations are forehead, nose, cheeks and chin; the periorbital region is usually not involved. Clinical features can be very heterogeneous. Besides different subtypes (erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea), which often overlap, various special forms of rosacea exist. Up to 60% of patients with cutaneous rosacea suffer from ocular rosacea. In Germany, brimonidine, metronidazol, azelaic acid, and ivermectin are approved for topical therapy of rosacea; for systemic therapy, doxycycline at a subantimicrobial dose (40 mg/day) is the only approved substance. In case of resistance to this therapy, contraindications or side effects, various alternative therapies are available, however off-label.