Ocular Rosacea: An Updated Review

Abstract

Purpose: Ocular rosacea is a chronic inflammatory disorder affecting the ocular surface, often associated with cutaneous rosacea. This review aims to explore its pathogenesis, treatment approaches, and future directions for management.

Methods: A review of current literature on the pathophysiology, clinical features, and treatment strategies of ocular rosacea in adults and children (pediatric blepharokeratoconjunctivitis) was conducted. Emerging research on immune dysregulation, microbiome alterations, and potential therapeutic targets was analyzed.

Results: Ocular rosacea involves dysregulation of the immune and neurovascular systems, with toll-like receptor activation and complement system involvement leading to chronic ocular surface inflammation. Alterations in the ocular microbiome have been implicated in disease progression. Treatment strategies emphasize a stepwise approach, incorporating ocular and skin hygiene, lifestyle modifications, and pharmacological interventions. Recent advancements in understanding the disease mechanisms have led to the exploration of targeted therapies, including biologics and small-molecule inhibitors.

Conclusions: Ocular rosacea remains challenging to diagnose and treat, particularly in children (pediatric blepharokeratoconjunctivitis), often leading to delayed intervention and poor outcomes. A multidisciplinary approach, including new therapeutic options, holds promise for improving patient care. Further research into the genetic and molecular basis of ocular rosacea may enable more personalized treatments.

FIGURE 1.

Representative images of a male patient with ocular rosacea. A, Bilateral asymmetric recurrent and chronic red eye. The face has classic signs of rhinophyma, skin papules, telangiectasias, flushing, and hyperemia. B and C, Right eye with marked hyperemia and localized ciliary injection; discrete peripheral marginal infiltrates; chronic meibomian gland dysfunction with eyelid margin hyperemia, telangiectasias, meibomian gland clogging, and thickened meibum; and anterior blepharitis with eyelash scales. D, Left eye shows a mild red eye and signs of a partially healed hordeolum at his inferior eyelid border.

FIGURE 2.

Ocular manifestations of rosacea. A, Chronic red eye in ocular rosacea. Recurrent asymmetric red eye. B, After careful exploration of the superior corneal pannus with localized ciliary injection, discrete peripheral marginal infiltrates are observed. C, In addition to chronic posterior blepharitis with eyelid margin hyperemia, telangiectasias, meibomian gland clogging, and thickened meibum are observed.

FIGURE 3.

Corneal involvement in ocular rosacea. A, Facial characteristics of rosacea with skin papules, pustules, hyperemia, telangiectasia, and rhinophyma. B, Peripheral corneal perforation sealed with uvea. The cornea has extensive scarring and neovascularization. Other areas of the cornea show peripheral marginal and phlyctenular corneal scars with neovessels. Remnants of a failed conjunctival graft are observed. C, D, and E, Bilateral neovascularized corneal scar involving the anterior and central stroma.

FIGURE 4.

Representative images of patients with pediatric ocular rosacea or pediatric blepharokeratoconjunctivitis. A, The right eye of a patient with a marginal scar and neovascularization (arrow). B, The left eye of the same patient shown in A, with a more severe corneal scar with lipid deposits and neovascularization. C, Central corneal scar involving the anterior and middle stroma of an 8-year-old patient. D, The same patient as in C after deep anterior lamellar keratoplasty.