eMedicine Specialties > Ophthalmology > Dermatologic Disorders

Ocular Rosacea: Differential Diagnoses & Workup

Author: J Bradley Randleman, MD, Associate Professor, Department of Ophthalmology, Section of Cornea, External Disease and Refractive Surgery, Emory University School of Medicine; Director of Cornea, External Disease and Refractive Surgery Fellowship, Emory University; Physician Member, Section of Ophthalmology, The Emory Clinic
Coauthor(s): Evan S Loft, MD, Staff Physician, Department of Ophthalmology, Emory University; C Diane Song, MD, Chief of Ophthalmology, Asheville Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Feb 20, 2009

Differential Diagnoses

Blepharitis, Adult
Corneal Erosion, Recurrent
Central Sterile Corneal Ulceration
Dermatitis, Atopic
Chalazion
Dry Eye Syndrome
Chlamydia
Episcleritis
Cicatricial Pemphigoid
Keratitis, Bacterial
Conjunctivitis, Allergic
Keratoconjunctivitis, Atopic
Conjunctivitis, Bacterial
Keratoconjunctivitis, Sicca
Conjunctivitis, Viral
Ulcer, Corneal

Workup

Laboratory Studies

  • The diagnosis of ocular rosacea is established clinically and is often aided by dermatologic findings. Laboratory studies are not indicated.

Imaging Studies

  • Imaging studies are not indicated.

Other Tests

  • Other tests are not indicated.

Histologic Findings

The conjunctiva in ocular rosacea is infiltrated by inflammatory cells, T-helper/T-suppressor (CD4) cells, phagocytic cells, and antigen-presenting cells. In addition, increased vascular dilation and occasionally granulomatous changes are present. None of these changes are specific for rosacea.

Patients with rosacea typically have a mean increase of nearly all cell types, but especially T-helper cells. 

Hoang-Xuan et al demonstrated a 3.5-fold increase in the ratio of CD4 cells to CD8 cells in the conjunctiva of patients with rosacea, most resembling a type IV hypersensitivity reaction.13

More on Ocular Rosacea

Overview: Ocular Rosacea
Differential Diagnoses & Workup: Ocular Rosacea
Treatment & Medication: Ocular Rosacea
Follow-up: Ocular Rosacea
Multimedia: Ocular Rosacea
References

References

  1. Buechner SA. Rosacea: an update. Dermatology. 2005;210(2):100-8. [Medline].

  2. Knox CM, Smolin G. Rosacea. Int Ophthalmol Clin. Spring 1997;37(2):29-40. [Medline].

  3. Powell FC. Clinical practice. Rosacea. N Engl J Med. Feb 24 2005;352(8):793-803. [Medline].

  4. Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol. Apr 2002;46(4):584-7. [Medline].

  5. Akpek EK, Merchant A, Pinar V, Foster CS. Ocular rosacea: patient characteristics and follow-up. Ophthalmology. Nov 1997;104(11):1863-7. [Medline].

  6. Browning DJ, Proia AD. Ocular rosacea. Surv Ophthalmol. Nov-Dec 1986;31(3):145-58. [Medline].

  7. Wilkin JK. Rosacea. Pathophysiology and treatment. Arch Dermatol. Mar 1994;130(3):359-62. [Medline].

  8. Tisma VS, Basta-Juzbasic A, Jaganjac M, et al. Oxidative stress and ferritin expression in the skin of patients with rosacea. J Am Acad Dermatol. Feb 2009;60(2):270-6. [Medline].

  9. Chamaillard M, Mortemousque B, Boralevi F, et al. Cutaneous and ocular signs of childhood rosacea. Arch Dermatol. Feb 2008;144(2):167-71. [Medline].

  10. Viso E, Rodriguez-Ares MT, Gude F. Prevalence of and associated factors for dry eye in a Spanish adult population (the Salnes Eye Study). Ophthalmic Epidemiol. Jan-Feb 2009;16(1):15-21. [Medline].

  11. Icasiano E, Latkany R, Speaker M. Chronic epiphora secondary to ocular rosacea. Ophthal Plast Reconstr Surg. May-Jun 2008;24(3):249. [Medline].

  12. Frucht-Pery J, Sagi E, Hemo I, Ever-Hadani P. Efficacy of doxycycline and tetracycline in ocular rosacea. Am J Ophthalmol. Jul 15 1993;116(1):88-92. [Medline].

  13. Modi S, Harting M, Rosen T. Azithromycin as an alternative rosacea therapy when tetracyclines prove problematic. J Drugs Dermatol. Sep 2008;7(9):898-9. [Medline].

  14. Torresani C. Clarithromycin: a new perspective in rosacea treatment. Int J Dermatol. May 1998;37(5):347-9. [Medline].

  15. Barnhorst DA Jr, Foster JA, Chern KC, Meisler DM. The efficacy of topical metronidazole in the treatment of ocular rosacea. Ophthalmology. Nov 1996;103(11):1880-3. [Medline].

Further Reading

Keywords

ocular rosacea, rosacea, adult acne, inflammatory keratitis, corneal ulceration, corneal perforation

Contributor Information and Disclosures

Author

J Bradley Randleman, MD, Associate Professor, Department of Ophthalmology, Section of Cornea, External Disease and Refractive Surgery, Emory University School of Medicine; Director of Cornea, External Disease and Refractive Surgery Fellowship, Emory University; Physician Member, Section of Ophthalmology, The Emory Clinic
J Bradley Randleman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Cornea Society, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Evan S Loft, MD, Staff Physician, Department of Ophthalmology, Emory University
Evan S Loft, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

C Diane Song, MD, Chief of Ophthalmology, Asheville Veterans Affairs Medical Center
C Diane Song, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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