Rosacea keratitis

Cornea neovascularization in rosacea keratitis

Typical facial feature in acne rosacea

Acne rosacea is a common skin condition of unknown origin. Ocular involvement is common but most tend to be mild. 
In the examination, the cases seen will have severe keratitis and since the ocular problems is more severe in males 
most patients will be males. This is another case in which observation of the whole patient is important before starting 
the slit-lamp examination otherwise the facial changes may be easily missed.

The eyelids show blepharoconjunctivitis sometimes with thick meibomian secretion (chalazion may be present). There 
may be scars on the tarsal conjunctiva suggesting previous recurrent chalazion. The cornea show pannus with or 
without peripheral corneal thinning. There are subepithelial opacities especially inferiorly. 

The face of the patient may have one or more of the following:

  • papules and pustules
  • facial hyperaemia
  • dilated facial vessels (telangiectasia)
  • in severe cases there may be rhinophyma
Other signs which may be present:
  • In severe rosacea keratitis, corneal perforation can occur. Signs of previous perforation include pigment in the 

  • cornea stroma and distorted iris. The patient may also have tetonic graft for peripheral corneal perforation.


1. How would you manage the ocular problem of acne rosacea?

2. A patient who is three-month pregnant develops severe blepharitis and keratitis secondary to acne rosacea.
    Would you prescribe doxycycline?

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