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Purpose: The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment. Methods: The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively). Results: The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3–18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001). Conclusion: This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical characteristics and treatment strategies of limbal stem cell deficiency (LSCD) patients managed with medical therapy. Materials and Methods: The study included 29 eyes of 21 patients with LSCD who were managed medically at Ege University Faculty of Medicine, Department of Ophthalmology between May 2013 and May 2023. LSCD stages before and after medical treatment were recorded according to the LSCD staging system published by the International LSCD Working Group. The medical records of patients showing improvement in LSCD stage with medical treatment without surgical intervention were evaluated. Results: The mean age was 35.5±23.8 years (range, 5-71 years) with a male-to-female ratio of 6:15. The primary etiology of LSCD was ocular rosacea in 12 patients (57.1%), marginal keratitis in the setting of blepharitis in 8 patients (38.1%), and topical medication toxicity in 1 patient (4.8%). The mean baseline best corrected visual acuity (BCVA) was 0.25±0.26 logarithm of the minimum angle of resolution (logMAR) (range, 0-1 logMAR). Pre-treatment LSCD stage was stage 1A in 5 eyes (17.2%), stage 1B in 12 eyes (41.4%), stage 1C in 4 eyes (13.8%), stage 2A in 4 eyes (13.8%), and stage 2B in 4 eyes (13.8%). Complete regression of LSCD was achieved in 6 eyes (20.7%) with medical treatment addressing the primary etiology. In the remaining eyes, after medical treatment, the severity of LSCD decreased below the surgical threshold, which is considered stage 2B. The mean final BCVA was 0.07±0.1 logMAR (range, 0-0.4 logMAR). Conclusion: This study highlights that LSCD can be completely or partially reversible with appropriate management, especially in cases with underlying limbal niche dysfunction, where inflammation plays a significant role. Although limbal stem cell transplantation is considered the main treatment approach for LSCD, localized and early-stage LSCD can be effectively managed medically without the need for surgical intervention. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical characteristics and treatment strategies of limbal stem cell deficiency (LSCD) patients managed with medical therapy. Materials and Methods: The study included 29 eyes of 21 patients with LSCD who were managed medically at Ege University Faculty of Medicine, Department of Ophthalmology between May 2013 and May 2023. LSCD stages before and after medical treatment were recorded according to the LSCD staging system published by the International LSCD Working Group. The medical records of patients showing improvement in LSCD stage with medical treatment without surgical intervention were evaluated. Results: The mean age was 35.5±23.8 years (range, 5-71 years) with a male-to-female ratio of 6:15. The primary etiology of LSCD was ocular rosacea in 12 patients (57.1%), marginal keratitis in the setting of blepharitis in 8 patients (38.1%), and topical medication toxicity in 1 patient (4.8%). The mean baseline best corrected visual acuity (BCVA) was 0.25±0.26 logarithm of the minimum angle of resolution (logMAR) (range, 0-1 logMAR). Pre-treatment LSCD stage was stage 1A in 5 eyes (17.2%), stage 1B in 12 eyes (41.4%), stage 1C in 4 eyes (13.8%), stage 2A in 4 eyes (13.8%), and stage 2B in 4 eyes (13.8%). Complete regression of LSCD was achieved in 6 eyes (20.7%) with medical treatment addressing the primary etiology. In the remaining eyes, after medical treatment, the severity of LSCD decreased below the surgical threshold, which is considered stage 2B. The mean final BCVA was 0.07±0.1 logMAR (range, 0-0.4 logMAR). Conclusion: This study highlights that LSCD can be completely or partially reversible with appropriate management, especially in cases with underlying limbal niche dysfunction, where inflammation plays a significant role. Although limbal stem cell transplantation is considered the main treatment approach for LSCD, localized and early-stage LSCD can be effectively managed medically without the need for surgical intervention.

Background/Objective: The aim of this study was to compare thiol/disulfide homeostasis and clinical parameters of rosacea patients across skin subtypes of the disease and healthy controls. Methods: This prospective study included 90 rosacea patients with different skin subtypes (phymatous, erythematotelangiectatic and papulopustular) and ocular involvement and 30 healthy controls. Plasma native thiol (NT), total thiol (TT) and disulfide levels of the patients and controls were measured using an automated spectrophotometric method, and disulfide/native thiol ratio (DNTR), disulfide/total thiol ratio (DTTR) and native thiol/total thiol ratio (NTTR) were calculated. Tear breakup time (TBUT), meiboscore, Schirmer, ocular surface disease index (OSDI) and rosacea-specific quality of life scale (RosaQoL) were measured clinically. Results: Disulfide, DNTR and DTTR were significantly higher, and NT, TT and NTTR were significantly lower in the rosacea patients compared to the controls (p < 0.001). TBUT and Schirmer were significantly lower, and meiboscore and OSDI were significantly higher in the patients compared to the controls (p < 0.01). According to the skin subtypes, disulfide, DNTR and DTTR were significantly higher, and NTTR was significantly lower in the erythematotelangiectatic subtype compared to the other subtypes (p < 0.002). TBUT was significantly lower, and RosaQol was significantly higher in the erythematotelangiectatic subtype (p < 0.0083). Strong correlations were found between DNTR and TBUT and between DNTR and Meiboscore in all subtypes (p < 0.005), while there were strong correlations between DNTR and OSDI and between DNTR and RosaQol only in the erythematotelangiectatic and papulopustular subtypes (p < 0.05). Conclusions: The thiol/disulfide homeostasis shifted towards disulfides, an indicator of oxidative stress in rosacea, and this was more pronounced in the erythematotelangiectatic subtype. The impairment in TBUT and RosaQol was also more prominent in the erythematotelangiectatic subtype and strongly associated with the DNTR. [ABSTRACT FROM AUTHOR]

Background: To compare the choroidal thickness (CT) and choroidal vascularity index (CVI) values in ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls. Methods: This prospective study included 90 eyes of 90 mild-moderate OR patients with different skin subtypes (30 phymatous, 30 papulopustular and 30 erythematotelangiectatic) and 30 eyes of 30 age-gender matched healthy volunteers. After obtaining the enhanced depth imaging optical coherence tomography images, the CT was measured at subfoveal, 1500 μm nasal and 1500 μm temporal to the fovea, and the CVI was calculated using Image J software in the subfoveal, nasal and temporal areas. Results: There was no CT significant difference between OR patients and healthy controls in all regions (p > 0.05). CVI values of OR patients were found to be significantly lower in the subfoveal, nasal and temporal regions compared to healthy controls (p = 0.02, p = 0.01, p = 0.01, respectively). No CT difference was detected between the subtypes and healthy controls in all regions (p > 0.05). Subfoveal-CVI was significantly lower in the phymatous subtype than the other subtypes and controls (p < 0.05), while nasal and temporal-CVI were significantly lower in the phymatous and papulopustular subtypes than the erythematotelangiectatic subtype and controls. Conclusion: Our study demonstrated no difference between rosacea skin types and healthy controls in terms of CT. Phymatous and papulopustular subtypes were more likely to be affected by chronic inflammation with having lower CVI in most of the regions. Further studies are needed to investigate the association of inflammatory factors with CVI in OR.

BackgroundOcular rosacea is common and is often managed with long-term antibiotic treatment. Doxycycline is the most commonly selected antibiotic for the treatment of rosacea. As there is no established standard of care treatment dose for rosacea, prescribed doses of doxycycline vary widely. The FDA classifies 40 mg daily dose of doxycycline for ocular rosacea as sub-microbial in comparison to an antibiotic dose of 200 mg daily. However, this "sub-microbial" dose has never been evaluated in patients with ocular rosacea, and even the sub-microbial dose has potential to alter systemic mucosa flora. Here, we present a randomized controlled trial using RNA sequencing to fully characterize the impact of sub-microbial antibiotic dosing of doxycycline on antimicrobial resistance and bacterial composition of the ocular and gut flora.MethodsIn a triple-masked parallel randomized control trial, patients with ocular rosacea will be randomized to three arms: a 40-mg dose of doxycycline, a 200-mg antibiotic dose of doxycycline, or placebo. Collected rectal and lower eyelid samples will be compared for frequency of antimicrobial resistance genetic determinants and microbiome diversity. A subjective ocular surface disease index survey and objective tear breakup time measurement will be determined.DiscussionThese results will enhance our understanding of the overall systemic impact of long-term systemic sub-microbial antibiotic dosing for the treatment of chronic recurrent ocular inflammatory diseases.Trial registrationThis trial was registered on ClinicalTrials.org (NCT05296837) on March 22, 2022.

This case is presented to (1) improve the efficacy of the identification and differential diagnosis and to avoid mistreatment of the skin manifestations of ocular rosacea exhibiting a clinical appearance of those of other disorders and (2) explore opportunities for building dermatologic and ophthalmologic collaboration in the management of patients with ocular symptoms of rosacea. A 33-year-old female patient was diagnosed with acne vulgaris and seborrhea oleosa by a dermatologist. She received a secondary diagnosis of adrenal hyperandrogenism, iron deficiency anemia and selenium and iodine deficiency. The patient underwent facial skin peeling and was prescribed dermatological treatment. Thereafter, she presented to an ophthalmologist and complained of gritty eyes and blurred vision which she had never before experienced. Ocular manifestations included macerated skin of the eyelid angles, palpebral edema, crusts at the eyelid margin and eyelid telangiectasia. The patient was diagnosed with ocular rosacea, dry eye and keratoconjunctivitis sicca, and obtained the prescribed ophthalmological treatment which resulted in an improvement in her ocular symptoms. Therefore, ocular rosacea should be treated through the cooperative efforts of dermatologists and ophthalmologists based on the constellation of clinical findings and symptoms in a particular case.

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Copyright of Die Dermatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Ocular rosacea is common and is often managed with long-term antibiotic treatment. Doxycycline is the most commonly selected antibiotic for the treatment of rosacea. As there is no established standard of care treatment dose for rosacea, prescribed doses of doxycycline vary widely. The FDA classifies 40 mg daily dose of doxycycline for ocular rosacea as sub-microbial in comparison to an antibiotic dose of 200 mg daily. However, this “sub-microbial” dose has never been evaluated in patients with ocular rosacea, and even the sub-microbial dose has potential to alter systemic mucosa flora. Here, we present a randomized controlled trial using RNA sequencing to fully characterize the impact of sub-microbial antibiotic dosing of doxycycline on antimicrobial resistance and bacterial composition of the ocular and gut flora. Methods In a triple-masked parallel randomized control trial, patients with ocular rosacea will be randomized to three arms: a 40-mg dose of doxycycline, a 200-mg antibiotic dose of doxycycline, or placebo. Collected rectal and lower eyelid samples will be compared for frequency of antimicrobial resistance genetic determinants and microbiome diversity. A subjective ocular surface disease index survey and objective tear breakup time measurement will be determined. Discussion These results will enhance our understanding of the overall systemic impact of long-term systemic sub-microbial antibiotic dosing for the treatment of chronic recurrent ocular inflammatory diseases. Trial registration This trial was registered on ClinicalTrials.org (NCT05296837) on March 22, 2022.

This case is presented to (1) improve the efficacy of the identification and differential diagnosis and to avoid mistreatment of the skin manifestations of ocular rosacea exhibiting a clinical appearance of those of other disorders and (2) explore opportunities for building dermatologic and ophthalmologic collaboration in the management of patients with ocular symptoms of rosacea. A 33-year-old female patient was diagnosed with acne vulgaris and seborrhea oleosa by a dermatologist. She received a secondary diagnosis of adrenal hyperandrogenism, iron deficiency anemia and selenium and iodine deficiency. The patient underwent facial skin peeling and was prescribed dermatological treatment. Thereafter, she presented to an ophthalmologist and complained of gritty eyes and blurred vision which she had never before experienced. Ocular manifestations included macerated skin of the eyelid angles, palpebral edema, crusts at the eyelid margin and eyelid telangiectasia. The patient was diagnosed with ocular rosacea, dry eye and keratoconjunctivitis sicca, and obtained the prescribed ophthalmological treatment which resulted in an improvement in her ocular symptoms. Therefore, ocular rosacea should be treated through the cooperative efforts of dermatologists and ophthalmologists based on the constellation of clinical findings and symptoms in a particular case. [ABSTRACT FROM AUTHOR]

Aim: Rosacea is a chronic inflammatory dermatological disease characterized with erythema, telangiectasias, papules and pustules that is seen more frequently in individuals with fair skin. Our purpose in this study is to compare choroidal measurements of rosacea patients with healthy individuals. Materials and Methods: Right eyes of 30 patients with ocular rosacea and right eyes of 30 healthy participants matched in terms of age and sex were included in the study. Choroid thicknesses were measured manually using optical coherent tomography device from the central subfovea; from the temporal as 1000 μm horizontally from the fovea and from the nasal. Results: Subfoveal, temporal and nasal choroidal thicknesses were measured as 351.90 μm±103, 335.10±100 μm, 322.00±99 μm, respectively in the ocular rosacea group; as 323.50±61 μm, 311.95±63, 302.35±61 μm, respectively in the control group. However, all these differences were not found to be statistically significant (p>0.05). Conclusion: Though many vascular disorders are observed in ocular rosacea, choroidal thickness is not affected by them. New studies including more patients with a longer period of follow-up are needed in this field. [ABSTRACT FROM AUTHOR]

Background and Design: Demodex, a mite, is known to influence the etiopathogenesis of rosacea, pityriasis folliculorum, pustular folliculitis, perioral granulomatous dermatitis, hyperpigmented patch, and chronic blepharitis. This study aimed to investigate the relationship between Demodex, which is increasingly important in the pathogenesis of rosacea, and ocular rosacea. Materials and Methods: A total of 103 rosacea patients with ocular involvement (ocular rosacea) and 140 volunteers without facial dermatosis were included in the study as the control group. Written and verbal consent was obtained from the participants. A total of five eyelashes were pulled from the upper and lower eyelids of one or both eyes of the patient group and control group, using forceps, and the presence of Demodex was examined by the epilation method and standard superficial skin biopsy method from the face. Under a light microscope, ≥1 and ≥5 Demodex per cm2 in the eyelashes and face were evaluated as positive, respectively. Results: Of the 103 patients, 27 (26.2%) had conjunctivitis, 77 (74.8%) had blepharitis, 1 (1%) had hordeolum, and 24 (23.3%) had meibomian gland dysfunction. The eye examination findings of the control group were normal. The Demodex incidence rates were 84.5% and 29.3% in the patient group and control group, respectively. Of the 103 patients with rosacea accompanied by ocular rosacea, Demodex mites were present in the eyelashes and face of 51 patients (49.6%), only in the eyelashes in 26 (25.2%), and only in the face in 10 (9.7%). No Demodex mites were present on both eyelashes and face in 16 (15.5%) patients. Conclusion: The results of this study show that Demodex positivity was detected at a higher rate in the eyelashes and face in patients with rosacea compared with the controls. Demodex may play an important role in the pathogenesis of rosacea and ocular rosacea.

• Choroidal vascularity index was significantly lower in the subfoveal, nasal and temporal regions of ocular rosacea patients compared to healthy controls. • Subfoveal choroidal vascularity index was significantly lower in the phymatous subtype than the other subtypes and healthy controls. • Nasal and temporal choroidal vascularity indexes were significantly lower in the phymatous and papulopustular subtypes than the erythematotelangiectatic subtype and healthy controls. To compare the choroidal thickness (CT) and choroidal vascularity index (CVI) values in ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls. This prospective study included 90 eyes of 90 mild-moderate OR patients with different skin subtypes (30 phymatous, 30 papulopustular and 30 erythematotelangiectatic) and 30 eyes of 30 age-gender matched healthy volunteers. After obtaining the enhanced depth imaging optical coherence tomography images, the CT was measured at subfoveal, 1500 μm nasal and 1500 μm temporal to the fovea, and the CVI was calculated using Image J software in the subfoveal, nasal and temporal areas. There was no CT significant difference between OR patients and healthy controls in all regions (p > 0.05). CVI values of OR patients were found to be significantly lower in the subfoveal, nasal and temporal regions compared to healthy controls (p = 0.02, p = 0.01, p = 0.01, respectively). No CT difference was detected between the subtypes and healthy controls in all regions (p > 0.05). Subfoveal-CVI was significantly lower in the phymatous subtype than the other subtypes and controls (p < 0.05), while nasal and temporal-CVI were significantly lower in the phymatous and papulopustular subtypes than the erythematotelangiectatic subtype and controls. Our study demonstrated no difference between rosacea skin types and healthy controls in terms of CT. Phymatous and papulopustular subtypes were more likely to be affected by chronic inflammation with having lower CVI in most of the regions. Further studies are needed to investigate the association of inflammatory factors with CVI in OR. [ABSTRACT FROM AUTHOR]

Objectives:To report the most frequent signs in ocular rosacea and evaluate their association with skin findings.Materials and Methods:Fifty-one patients diagnosed with rosacea by a trained dermatologist were evaluated by an ocular surface specialist. A complete ophthalmological examination was performed.Results:In our study, the prevalence of ocular signs in patients with rosacea was 74.5%. The average age at presentation was 50 years and women were more affected than men. The most common findings were lid margin erythema, meibomian gland dysfunction, and blepharitis. Fifteen patients had decreased visual acuity due to complications related to rosacea such as leukoma and corneal neovascularization. Interestingly, patients that had the lowest visual acuity presented with dermatological signs of papules and pustules (p=0.001) and rhinophyma (p=0.023). Two patients who showed subepithelial fibrosis and fornix foreshortening were diagnosed as having ocular cicatricial pemphigoid (OCP) by immunohistopathological analysis of conjunctival specimens.Conclusion:Ocular compromise is common in rosacea. Our study shows that there might be a relationship between the severity of ocular involvement and certain subtypes of cutaneous disease. Rosacea and OCP may coexist. In cases that present with conjunctival fibrotic changes, a diagnostic biopsy is mandatory.

A 43-year-old female zoologist has an occupational dermatomycosis of the face, neck and upper part of chest caused by T. mentagrophytes. It was mistakenly diagnosed and treated as "Rosacea, papulopustular subtype, ocular rosacea" for 1.5 years. Symmetrical, atypical clinical manifestations with recurrent blepharoconjunctivitis developed as a result of self-treatment using a topical steroid. The detection of cicatrizing folliculitis in the eyebrow area and an arcual peripheral edge in fresh foci on the chest helped to suspect dermatomycosis. The definitive diagnosis was made after the detection of abundant coarse septate mycelium during microscopic investigation of skin scales from foci on the face and chest with 30% KOH and an abundant growth of Trichophyton mentagrophytes during a cultural research study of skin scales, eyebrow hair and eyelashes from lesions. The use of terbinafine for 4 weeks led to the recovery of the patient.

Background: The symptoms of ocular rosacea are often non-specific and there is no dependable diagnostic test for the disease, which may cause difficulties in diagnostics. The aim of this study was to examine the association between clinical findings of rosacea and self-reported ocular symptoms in a general population of middle-aged subjects. Methods: A clinical whole-body examination by a dermatologist was performed for 1,932 subjects belonging to the Northern Finland Birth Cohort 1966 Study. The presence of ocular symptoms was self-reported. The difference between rosacea and ocular symptoms was tested. Logistic regression analysis was used to identify associations between rosacea and ocular symptoms. Results: The prevalence of rosacea was 15.1% (n = 292); in the subjects with rosacea, erythematoteleangiectatic rosacea was found in 83.2% (n = 242), papulopustular in 15.4% (n = 45), ocular in 0.03% (n = 1), and phymatic in 0.1% (n = 3). Ocular symptoms in rosacea subjects were common, with dryness (32.3%), tearing (29.4%), foreign-body sensation (21.8%), and photophobia (20.5%) being the most common ones. Foreign-body sensation was reported significantly more often in those with rosacea compared to those without (p < 0.04). In logistic regression analyses, after adjusting, the subjects with rosacea had a 1.5-fold increased risk for decreased visual acuity in the dark (OR 1.48, 95% CI 1.01–2.14) compared to those without rosacea. Conclusion: Eye symptoms are common in subjects with rosacea. All patients with rosacea should be asked about ocular symptoms and both skin and eyelids should be examined even if the cutaneous findings are mild. [ABSTRACT FROM AUTHOR]

Introduction: Rosacea is a chronic inflammatory disease that affects the facial skin with eye involvement being underdiagnosed. Aim: To study the prevalence of ocular rosacea in patients of rosacea in a tertiary care centre. Materials and Methods: The present study was a cross-sectional study conducted at two tertiary level hospitals from January 2020 to December 2021. Cases of rosacea diagnosed were referred from the Departments of dermatology to the Departments of ophthalmology for ocular evaluation. A total of 400 patients were included in study in a multicentric setting. For ophthalmic evaluation, Ocular Surface Disease Index (OSDI) questionnaire was used. Results: Total 29 cases (7.25%) had ocular rosacea, out of 400 dermatological confirmed cases of rosacea. Amongst confirmed ocular rosacea, 12 (41.4%) were males and 17 (58.6%) were females. Most manifestations were noted in 41 to 60 years age with an average age of 52.2 years. Most of the cases presented with multiple symptoms and signs- 19 presented with features of dry eyes,16 had features of conjunctivitis, 6 had blepharitis, and 7 had recurrent chalazions. Conclusion: Ocular rosacea is a diagnostic enigma to clinicians as it is underdiagnosed because of overlapping sign and symptoms. This study emphasises ocular examination in all cases of rosacea.

Ocular rosacea is a chronic potentially sight-threatening inflammatory condition, which can occur in approximately 20% of patients without skin involvement. However, an accurate diagnosis of ocular rosacea has not been defined yet due to its rather nonspecific symptoms and clinical findings. Therefore, this article updates the current recommendations for diagnosis and treatment of ocular rosacea and the previously published consensus recommendations from the ROSCO expert panel on the management of rosacea. [ABSTRACT FROM AUTHOR]

Background and Design: Demodex, a mite, is known to influence the etiopathogenesis of rosacea, pityriasis folliculorum, pustular folliculitis, perioral granulomatous dermatitis, hyperpigmented patch, and chronic blepharitis. This study aimed to investigate the relationship between Demodex, which is increasingly important in the pathogenesis of rosacea, and ocular rosacea. Materials and Methods: A total of 103 rosacea patients with ocular involvement (ocular rosacea) and 140 volunteers without facial dermatosis were included in the study as the control group. Written and verbal consent was obtained from the participants. A total of five eyelashes were pulled from the upper and lower eyelids of one or both eyes of the patient group and control group, using forceps, and the presence of Demodex was examined by the epilation method and standard superficial skin biopsy method from the face. Under a light microscope, ≥1 and ≥5 Demodex per cm2 in the eyelashes and face were evaluated as positive, respectively. Results: Of the 103 patients, 27 (26.2%) had conjunctivitis, 77 (74.8%) had blepharitis, 1 (1%) had hordeolum, and 24 (23.3%) had meibomian gland dysfunction. The eye examination findings of the control group were normal. The Demodex incidence rates were 84.5% and 29.3% in the patient group and control group, respectively. Of the 103 patients with rosacea accompanied by ocular rosacea, Demodex mites were present in the eyelashes and face of 51 patients (49.6%), only in the eyelashes in 26 (25.2%), and only in the face in 10 (9.7%). No Demodex mites were present on both eyelashes and face in 16 (15.5%) patients. Conclusion: The results of this study show that Demodex positivity was detected at a higher rate in the eyelashes and face in patients with rosacea compared with the controls. Demodex may play an important role in the pathogenesis of rosacea and ocular rosacea. [ABSTRACT FROM AUTHOR]

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.

Acne rosacea is a chronic skin condition with exacerbations and remissions, which requires long-term therapy to maintain symptomatic control. Etiology of rosacea is not fully understood and more than 50% of patients with rosacea have ocular manifestations such as blepharitis, conjunctival hyperemia, and rosacea-associated keratitis. Sight-threatening disease is rare with rosacea; however, keratitis can result in corneal ulceration and eventual perforation if not treated aggressively. Here, in my case, there is acne rosacea associated with blepharitis, dryness, peripheral keratitis, and eventually landed up with corneal perforation which then managed with corneal grafting.

Samantha Sagaser,1 Richard Butterfield,2 Heidi Kosiorek,2 Yael Kusne,3 Juan Maldonado,4,5 Michael P Fautsch,6 Dharmendra Patel,3 Joanne F Shen3 1Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA; 2Research Biostatistics, Mayo Clinic, Scottsdale, AZ, USA; 3Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA; 4Knowledge Enterprise, Genomics Core, Arizona State University, Tempe, AZ, USA; 5Center for Fundamental and Applied Microbiomics, The Biodesign Institute, Arizona State University, Tempe, AZ, USA; 6Ophthalmology, Mayo Clinic, Rochester, MN, USACorrespondence: Joanne F ShenMayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259, USAEmail Shen.Joanne@mayo.eduPurpose: 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-β 1, 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.Keywords: intense pulsed light, IPL, meibomian gland expression, dry eye disease, meibomian gland disorder, ocular rosacea, transforming growth factor-beta, TGF-β, tear cytokines, ocular microbiome, OSDI; ocular surface disease index

Objectives: To report the most frequent signs in ocular rosacea and evaluate their association with skin findings. Materials and Methods: Fifty-one patients diagnosed with rosacea by a trained dermatologist were evaluated by an ocular surface specialist. A complete ophthalmological examination was performed. Results: In our study, the prevalence of ocular signs in patients with rosacea was 74.5%. The average age at presentation was 50 years and women were more affected than men. The most common findings were lid margin erythema, meibomian gland dysfunction, and blepharitis. Fifteen patients had decreased visual acuity due to complications related to rosacea such as leukoma and corneal neovascularization. Interestingly, patients that had the lowest visual acuity presented with dermatological signs of papules and pustules (p=0.001) and rhinophyma (p=0.023). Two patients who showed subepithelial fibrosis and fornix foreshortening were diagnosed as having ocular cicatricial pemphigoid (OCP) by immunohistopathological analysis of conjunctival specimens. Conclusion: Ocular compromise is common in rosacea. Our study shows that there might be a relationship between the severity of ocular involvement and certain subtypes of cutaneous disease. Rosacea and OCP may coexist. In cases that present with conjunctival fibrotic changes, a diagnostic biopsy is mandatory. [ABSTRACT FROM AUTHOR]

Purpose: Chronic inflammation is a predisposing factor for metaplastic changes and ultimately dysplasia. We describe cases of OSSN occurring in the setting of chronic ocular surface inflammation., Methods: Sixteen eyes from 14 individuals were included from one ocular oncology clinic between 2010 and 2023. Patients presented with ocular surface squamous neoplasia (OSSN) in the setting of chronic inflammation. The diagnosis of OSSN was made using anterior segment high-resolution optical coherence tomography (HR-OCT) and confirmed by histopathological analysis in all cases., Results: Median age on presentation was 61 [IQR 47.5-69.2] years. Eleven (86%) individuals were male and five (36%) identified as White Hispanic. Ten eyes were referred with ocular surface diagnoses including pannus (n = 4), scarring (n = 3), pterygium (n = 2), and herpetic keratitis (n = 1). Only six eyes were referred as possible neoplasia. All individuals had a history of ocular surface inflammation. The most common inflammatory conditions were ocular rosacea (seven individuals) and atopic keratoconjunctivitis (AKC) (five individuals). Two individuals were found to have bilateral OSSN, one in the setting of ocular rosacea and the other in the setting of AKC. All 16 eyes from 14 individuals were suspected to have OSSN based on HR-OCT findings which guided the location of the incisional biopsies that subsequently confirmed histopathological diagnosis in all cases., Conclusion: OSSN may arise in the setting of chronic inflammation on the ocular surface. Identification of the tumor can be challenging in these cases, and HR-OCT can be a key diagnostic tool in detecting OSSN., (Copyright © 2024. Published by Elsevier Inc.)

Background: In addition to the non-specific symptomatology of ocular rosacea, currently, there are no reliable diagnostic tests for the disease, which may lead to its misdiagnosis. Here, we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids., Case Summary: A 63-year-old female patient presented with multiple chalazion and dry eyes in both eyes, with no facial erythema. Initial management done were application of steroid eye ointment on both eyelids, hot compresses, and eyelid margin cleaning; noting that there was no relief of symptoms. Surgical excision of the chalazion was done on both eyes, however, bilateral recurrence occurred post-operatively. The pathological studies showed infiltration of a small amount of fibrous tissue with many chronic inflammatory cells. Immunohistochemistry studies were positive for LL-37. Resolution of the chalazion occurred after oral administration of doxycycline and azithromycin., Conclusion: Our findings show that ophthalmologists should recognize the ocular manifestations of skin diseases., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: Rosacea is a chronic inflammatory disease that affects the facial skin with eye involvement being underdiagnosed. Aim: To study the prevalence of ocular rosacea in patients of rosacea in a tertiary care centre. Materials and Methods: The present study was a cross-sectional study conducted at two tertiary level hospitals from January 2020 to December 2021. Cases of rosacea diagnosed were referred from the Departments of dermatology to the Departments of ophthalmology for ocular evaluation. A total of 400 patients were included in study in a multicentric setting. For ophthalmic evaluation, Ocular Surface Disease Index (OSDI) questionnaire was used. Results: Total 29 cases (7.25%) had ocular rosacea, out of 400 dermatological confirmed cases of rosacea. Amongst confirmed ocular rosacea, 12 (41.4%) were males and 17 (58.6%) were females. Most manifestations were noted in 41 to 60 years age with an average age of 52.2 years. Most of the cases presented with multiple symptoms and signs- 19 presented with features of dry eyes, 16 had features of conjunctivitis, 6 had blepharitis, and 7 had recurrent chalazions. Conclusion: Ocular rosacea is a diagnostic enigma to clinicians as it is underdiagnosed because of overlapping sign and symptoms. This study emphasises ocular examination in all cases of rosacea. [ABSTRACT FROM AUTHOR]

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.

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Abstract 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.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare case of a 19-year-old girl who presented with spontaneous bilateral corneal perforation in a setting of ocular rosacea., Methods: Ocular rosacea was diagnosed and treated with doxycycline. Cyanoacrylate glue was applied to treat corneal perforations., Results: At six months follow up there is good healing, visual acuity has improved, anterior chamber is deep with no Seidel., Conclusions: Rosacea is a multifactorial disease with an unclear pathophysiology. The ocular manifestations of rosacea (ocular rosacea) may occur without skin involvement, are not specific and can range from mild blepharitis to sight-threatening conditions. This case shows how ocular rosacea can lead to serious vision-threatening complications with mild symptoms. Cyanoacrylate glue and systemic antibiotic treatment are effective treatments., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Stephanie R Fromstein, Jennifer S Harthan, Jaymeni Patel, Dominick L Opitz Department of Clinical Education, Illinois College of Optometry, Chicago, IL, USA Abstract: 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. Keywords: Demodex folliculorum, Demodex brevis, blepharitis, blepharoconjunctivitis, meibomian gland dysfunction, ocular rosacea

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 risk factor in the pathogenesis of oculofacial rosacea, meibomian gland dysfunction (MGD), and dry eye disease (DED). Recent studies suggested IPL to control or eradicate Demodex organisms in the periocular area. Despite encouraging reports, the direct effect of IPL on Demodex is not well understood. Methods: An eyelash infested with Demodex was epilated from a 62-year-old female patient with oculofacial rosacea. Following isolation and adherence of a mite onto a microscope slide, real-time video microscopy was used to capture live images of the organism before, during, and after administration of IPL pulses. IPL pulses were delivered with the M22 IPL (Lumenis), with IPL settings used for treatment of DED due to MGD (the ''Toyos protocol''). A noncontact digital laser infrared thermometer was used to measure the temperature of the slide. Results: Before the IPL pulses, legs of the Demodex mite spontaneously moved in a repetitive and semicircular motion. During administration of IPL, spontaneous movements of the legs continued. Immediately after administration of five IPL pulses, the temperature of the slide increased from room temperature to 49°C. Immediately afterward, the Demodex mite became completely immobilized. The legs appeared retracted, smoother, less corrugated, bulkier, and less well-defined. Movement of the Demodex mite was not observed at the hourly inspections for 5 h and after 24 h following the application of IPL pulses. Conclusions: Our video directly demonstrates the effect of IPL on a live Demodex mite extracted from a freshly epilated eyelash. The results suggest that IPL application with settings identical to those used for treatment of DED due to MGD causes a complete destruction of the organism. [ABSTRACT FROM AUTHOR]

Rosacea is a dermatologic condition that affects the midfacial region. This chronic inflammatory disease can present with ocular manifestations distinguished by meibomian gland dysfunction, dry eye, and in severe cases, corneal ulceration and perforation. Neurotrophic keratopathy is an ocular condition with a reduced or absent corneal sensation associated with a corneal epitheliopathy. We present a 68-year-old man with both ocular rosacea and neurotrophic keratopathy who developed a corneal perforation. It was managed successfully with a tectonic keratoplasty in addition to topical steroids, lubrication, and oral tetracyclines. The perforation is explained by the superposition of both pathologies which lead to dry eye syndrome, along with chronic inflammation of the ocular surface. The effective follow-up and treatment of any epithelial defect in these patients is a major factor for corneal melting and perforation prevention. [ABSTRACT FROM AUTHOR]