Ocular Rosacea Difficult to Detect in Dark-Skin Patients
Ocular rosacea while quite common, can easily go undetected in individuals with dark skin. Because ocular rosacea can have a sight-threatening prognosis, ophthalmologists should pay added attention to patients who present with ocular irritation and chronic severe meibomitis, explained Nibaran Gangopadhyay, MS, who described the clinical features and how best to manage the disorder at the annual meeting of the American Society of Cataract and Refractive Surgery.
Chronic meibomitis evident as inflamed lids with rounded lid margins and telangiectasia. The traditional definition defined this condition as follows: "Ocular rosacea is a chronic acneiform disorder that affects both the skin and eye. It is a syndromal etiology that is believed to be more common in Caucasian patients and nearly nonexistent in the black population," Dr. Gangopadhyay said. "However, when we started to look more carefully at non-Caucasian patients, we found that ocular rosacea was more common than had previously been believed."
Peripheral marginal keratitis with infiltration and vascularization affecting nearly a quadrant of the lower cornea, suggesting rosacea. "Twenty-two patients, 13 of whom were male, were found to have features of ocular rosacea. Studies in the literature report a slight female predominance, but more and more articles are reporting that the sexes are equally affected," Dr. Gangopadhyay said.
The mean patient age was 37.2 ± 17.1 years, with a range from 6 to 65 years. The original follow-up was about 6.4 months. Three patients were lost to follow-up.
Peripheral marginal keratitis with infiltration and vascularization affecting nearly a quadrant of the upper cornea, suggesting rosacea. (Figures courtesy of LV Prasad Eye Institute) "Twelve of the 22 patients had a history of ocular irritation, and half of them had been evaluated previously by an ophthalmologist," he said. "What was surprising was that none of our patients had received a diagnosis of skin involvement before we examined them." The previous diagnoses were marginal keratitis, sclerosing keratitis, Staphylococcus infection, fungal keratitis, corneal ulcer, chronic conjunctivitis, and so on.
Most of the patients had more than two symptoms; those appearing most often were redness (63.6%), watering (59.1%), pain (50%), and decreased vision (36.4%). The most common signs were meibomitis (90.8%), corneal scars (59.1%), and blepharitis (50%), with corneal scars being one of the most important causes of loss of visual acuity, according to Dr. Gangopadhyay.
Clinical features of ocular rosacea were found in only 9% of patients before a diagnosis of rosacea was established. Therefore, most disease was diagnosed when patients were examined by Dr. Gangopadhyay and his colleagues. "We diagnosed the disease in 70% of cases at the first presentation, but we missed the diagnosis in nearly a third of the cases," he said.
This seems to indicate that it's time to forget what we've been told about ocular rosacea and accept that we may all be at risk of this condition.
Chronic meibomitis evident as inflamed lids with rounded lid margins and telangiectasia. The traditional definition defined this condition as follows: "Ocular rosacea is a chronic acneiform disorder that affects both the skin and eye. It is a syndromal etiology that is believed to be more common in Caucasian patients and nearly nonexistent in the black population," Dr. Gangopadhyay said. "However, when we started to look more carefully at non-Caucasian patients, we found that ocular rosacea was more common than had previously been believed."
Peripheral marginal keratitis with infiltration and vascularization affecting nearly a quadrant of the lower cornea, suggesting rosacea. "Twenty-two patients, 13 of whom were male, were found to have features of ocular rosacea. Studies in the literature report a slight female predominance, but more and more articles are reporting that the sexes are equally affected," Dr. Gangopadhyay said.
The mean patient age was 37.2 ± 17.1 years, with a range from 6 to 65 years. The original follow-up was about 6.4 months. Three patients were lost to follow-up.
Peripheral marginal keratitis with infiltration and vascularization affecting nearly a quadrant of the upper cornea, suggesting rosacea. (Figures courtesy of LV Prasad Eye Institute) "Twelve of the 22 patients had a history of ocular irritation, and half of them had been evaluated previously by an ophthalmologist," he said. "What was surprising was that none of our patients had received a diagnosis of skin involvement before we examined them." The previous diagnoses were marginal keratitis, sclerosing keratitis, Staphylococcus infection, fungal keratitis, corneal ulcer, chronic conjunctivitis, and so on.
Most of the patients had more than two symptoms; those appearing most often were redness (63.6%), watering (59.1%), pain (50%), and decreased vision (36.4%). The most common signs were meibomitis (90.8%), corneal scars (59.1%), and blepharitis (50%), with corneal scars being one of the most important causes of loss of visual acuity, according to Dr. Gangopadhyay.
Clinical features of ocular rosacea were found in only 9% of patients before a diagnosis of rosacea was established. Therefore, most disease was diagnosed when patients were examined by Dr. Gangopadhyay and his colleagues. "We diagnosed the disease in 70% of cases at the first presentation, but we missed the diagnosis in nearly a third of the cases," he said.
This seems to indicate that it's time to forget what we've been told about ocular rosacea and accept that we may all be at risk of this condition.
posted by Nick Riley at 11:22 AM
