Ocular Rosacea Clinical Presentation

Updated: Mar 03, 2020
  • Author: Jitander Dudee, MD, MA(Cantab), FACS, FRCOphth; Chief Editor: Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC  more...
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Facial symptoms may include the following:

  • Recurrent flushing episodes

  • Persistent and/or recurrent midfacial erythema

  • Papular and pustular lesions

Ocular symptoms may include the following:

  • Dry eyes, [16] irritation, redness, itching, burning, foreign body sensation, and photophobia

  • Recurrent chalazia

  • Recurrent eye infections



Facial findings

Facial findings are as follows:

  • Telangiectasias

  • Papules and pustules (without comedones)

  • Rhinophyma (hypertrophy of sebaceous glands leading to bulbous deformity of the nose)

  • See the image below

    Typical findings of rosacea, including papules, pu Typical findings of rosacea, including papules, pustules, and rhinophyma.

Ocular findings

Ocular findings are as follows:

  • Eyelid (most common) [17]

    • Eyelid telangiectasias as depicted below

      Ocular rosacea. Eyelid telangiectasias with inspis Ocular rosacea. Eyelid telangiectasias with inspissated meibomian glands.
    • Blepharitis

    • Meibomian gland dysfunction

    • Thick viscous plugging of meibomian gland orifices

    • Hordeola/chalazia

  • Conjunctivitis

    • Usually chronic, diffuse hyperemia

    • Can lead to cicatrization in rare, severe cases

  • Corneal findings

    • Punctate epithelial keratopathy (PEK), usually in the inferior one third of the cornea

    • Marginal corneal infiltrates

    • Corneal neovascularization

    • Superficial, wedge-shaped (spade-like) peripheral vascularization with its base at the limbus

    • Can progress to frank corneal neovascularization and eventual opacification as shown below

      Ocular rosacea. Extensive corneal neovascularizati Ocular rosacea. Extensive corneal neovascularization and opacification.
    • Corneal thinning as depicted below, ulceration, and perforation

      Ocular rosacea. Extensive corneal pannus with thin Ocular rosacea. Extensive corneal pannus with thinning.
  • Secondary bacterial keratitis

  • Episcleritis, scleritis (rare)



Flushing triggers: These include alcohol, hot beverages, tobacco, spicy foods, vasodilating medications, and emotional stress.

UV light: This is postulated to decrease the competence of already dilated cutaneous vasculature, increasing persistent erythema and telangiectasias.

Demodex: This mite, which is part of the skin's normal flora, leads to stimulation of the innate immune system. Bacteria in the gut of Demodex may be the inciting factor rather than the Demodex itself. [11]

S epidermidis: Hyper-reactivity of the innate immune system in rosacea patients makes them sensitive to this normal skin flora. [12]

H pylori: This is postulated to be strongly correlated with rosacea. This is possibly due to a flush-inducing toxin present in H pylori.

Positive family history: Some studies have shown a higher rate of positive family history of rosacea in patients with this dermatologic disorder than in skin-healthy controls. [18]

Smoking: Some studies have shown an increased history of smoking in patients with rosacea as compared with skin-healthy controls. [18, 19]



Complications include corneal vascularization, ulceration, perforations, secondary bacterial infections, and, ultimately, decreased vision.