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Pellegrini F, Vincigiuerra A, Maria AD. Spontaneous bilateral corneal perforation in ocular Rosacea. Eur J Ophthalmol 2024; 34:NP5-NP7. [PMID: 37915114 DOI: 10.1177/11206721231212087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE To report a rare case of a 19-year-old girl who presented with spontaneous bilateral corneal perforation in a setting of ocular rosacea. METHODS Ocular rosacea was diagnosed and treated with doxycycline. Cyanoacrylate glue was applied to treat corneal perforations. RESULTS At six months follow up there is good healing, visual acuity has improved, anterior chamber is deep with no Seidel. CONCLUSIONS Rosacea is a multifactorial disease with an unclear pathophysiology. The ocular manifestations of rosacea (ocular rosacea) may occur without skin involvement, are not specific and can range from mild blepharitis to sight-threatening conditions. This case shows how ocular rosacea can lead to serious vision-threatening complications with mild symptoms. Cyanoacrylate glue and systemic antibiotic treatment are effective treatments.
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Kozhaya K, Mehanna CJ, Jacob S, Saad A, Jabbur NS, Awwad ST. Management of Anterior Stromal Necrosis After Polymethylmethacrylate ICRS: Explantation Versus Exchange With Corneal Allogenic Intrastromal Ring Segments. J Refract Surg 2022; 38:256-263. [PMID: 35412922 DOI: 10.3928/1081597x-20220223-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate management of keratoconic eyes with anterior stromal necrosis overlying the intracorneal ring segment (ICRS), by either ICRS explantation alone or exchange with corneal allogenic intrastromal ring segments (CAIRS). METHODS Among 643 Intacs SK (Additional Technology, Inc) inserted at one institutional center, 16 eyes (15 patients) with overlying spontaneous anterior stromal necrosis were identified. Data included size of stromal defect and refractive and topographical findings before ICRS insertion, before anterior stromal necrosis, and 6 months after intervention. RESULTS The 10-year incidence of anterior stromal necrosis after femtosecond laser-assisted ICRS insertion was 5.5%. Eight eyes underwent ICRS removal only and 8 eyes had ICRS exchanged with CAIRS. In the first group, CDVA worsened from 0.14 before melt to 0.28 logMAR after removal (P = .10), simulated keratometry (SimK) and maximum axial keratometry (Kmax) increased from 44.73 to 46.34 diopters (D) (P = .14) and from 49.23 to 52.26 D (P = .14), respectively, and coma worsened from 0.87 to 1.52 D (P = .02). In the CAIRS group, CDVA of 0.16 before melt improved to 0.11 logMAR postoperatively (P > .99), and topographic indices stabilized with SimK, Kmax, and coma mildly altering from 45.31 to 45.44 D (P > .99), from 49.25 to 49.64 D (P > .99) and from 0.87 to 0.81 D (P > .99), respectively. Whether the ICRS were explanted or exchanged, the visual and topographic mean values were better than those reported before ICRS implantation, whereas higher order aberrations in eyes without CAIRS regressed to levels before ICRS insertion. At the site of melt, thinnest residual stromal thickness averaged 327 µm with ICRS removal and 490 µm with CAIRS. Eyes with larger melt areas resulted in less optimal results with CAIRS implantation. CONCLUSIONS Early experience in the management of anterior stromal necrosis by exchange of polymethylmethacrylate ICRS with CAIRS seems to avoid stromal thinning and confer better visual and topographic results, which were more pronounced with thicker segments. The benefit of CAIRS in large stromal melts needs to be investigated. [J Refract Surg. 2022;38(4):256-263.].
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Abstract
Ocular rosacea is a chronic potentially sight-threatening inflammatory condition, which can occur in approximately 20% of patients without skin involvement. However, an accurate diagnosis of ocular rosacea has not been defined yet due to its rather nonspecific symptoms and clinical findings. Therefore, this article updates the current recommendations for diagnosis and treatment of ocular rosacea and the previously published consensus recommendations from the ROSCO expert panel on the management of rosacea.
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Affiliation(s)
- Bianka Sobolewska
- Centre for Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Martin Schaller
- Department of Dermatology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Manfred Zierhut
- Centre for Ophthalmology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
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Ozturk T, Kayabasi M, Ozbagcivan O, Ayhan Z, Utine CA. Common ocular findings in patients with acne rosacea. Int Ophthalmol 2021; 42:1077-1084. [PMID: 34727263 DOI: 10.1007/s10792-021-02093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate ocular surface manifestations in patients with acne rosecea (AR) and to find out main features indicating a propensity toward an association with disease diagnosis. METHODS Right eyes of consecutive 76 AR patients and 113 age-gender matched healthy subjects were enrolled. Ophthalmologic examinations including tear break-up time (t-BUT) and Schirmer-2 tests to analyze tear film insufficiency, optical coherence tomography (OCT)-assisted infrared meibography to analyze meibomian gland drop-out, and Ocular Surface Disease Index (OSDI) questionnaire were performed in all participants. RESULTS No statistically differences were found in visual acuity, intraocular pressure, central corneal thickness, and axial length assessments between the study and control eyes. Study eyes had more foreign body sensation, itching, dryness, hyperemia, conjunctival telangiectasia, and meibomitis (p ≤ 0.005, for all). Significantly higher t-BUT and Schirmer-2 tests; lower-eyelid and total OCT meibography; and OSDI scores were found in AR patients (p < 0.05, for all). Among all, only conjunctival telangiectasia (p = 0.001; OR:0.070, 95% CI:0.015-0.330) was found to be major independent predictor for AR diagnosis. CONCLUSION Detailed slit-lamp examination to detect any conjunctival telangiectasia seems to be crucial in recalcitrant dry eye cases, not to miss underlying AR. Especially, lower-eyelid OCT meibography score may be sensitively used for disease staging.
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Affiliation(s)
- Taylan Ozturk
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey.
| | - Mustafa Kayabasi
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey
| | - Ozlem Ozbagcivan
- Department of Dermatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey
| | - Canan Asli Utine
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey
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Wladis EJ, Adam AP. Immune signaling in rosacea. Ocul Surf 2021; 22:224-229. [PMID: 34481075 DOI: 10.1016/j.jtos.2021.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
Rosacea is a common chronic skin disease affecting mostly people aged 40 and above, with currently no cure. When it affects the eyelids and periocular skin, it leads to dry eye and potentially corneal damage. Research performed over the last decade shed light into the potential mechanisms leading to skin hypersensitivity and provided promising avenues for development of novel, rational therapeutics aimed at reducing the skin inflammatory state. In this review, we discuss the current knowledge on the mechanisms of rosacea in general and of periocular skin-affecting disease in particular, identify key questions that remain to be answered in future research, and offer a disease model that can explain the key characteristics of this disease, with particular emphasis on a potential positive feedback loop that could explain both the acute and chronic features of rosacea.
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Affiliation(s)
- Edward J Wladis
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College, 1220 New Scotland Rd, Suite 302, Slingerlands, NY, 12159, United States.
| | - Alejandro P Adam
- Department of Molecular and Cellular Physiology and Department of Ophthalmology, Albany Medical College, United States
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Woo YR, Cho M, Ju HJ, Bae JM, Cho SH, Lee JD, Kim HS. Ocular Comorbidities in Rosacea: A Case-Control Study Based on Seven Institutions. J Clin Med 2021; 10:jcm10132897. [PMID: 34209731 PMCID: PMC8267744 DOI: 10.3390/jcm10132897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 01/03/2023] Open
Abstract
Rosacea is a facial inflammatory dermatosis that is linked with various systemic illnesses. With regards to the eye, rosacea patients have been described to manifest ocular surface changes, such as blepharitis and conjunctivitis. However, studies that examine the association of rosacea with a wider array of ocular diseases are limited. Thus, our aim was to identify the range of ocular comorbidities in the Korean patient population and create a reference data set. A multi-institutional, case-control study was conducted, where 12,936 rosacea patients and an equal number of sex- and age-matched control subjects were extracted over a 12-year period. We were able to discover a notable association between rosacea and blepharitis (adjusted odds ratio (aOR) 3.44; 95% confidence interval, 2.71–4.36, p < 0.001), conjunctivitis (aOR 1.65; 95% CI, 1.50–1.82, p < 0.001), glaucoma (aOR 1.93; 95% CI, 1.70–2.20, p < 0.001), dry eye syndrome (aOR 1.89; 95% CI, 1.70–2.09, p < 0.001), and chalazion (aOR 3.26; 95% CI, 1.41–7.57, p = 0.006) from logistic regression analysis. Female subjects and individuals younger than 50 exclusively showed higher odds for chalazion. Our study suggests that ocular comorbidities (i.e., glaucoma, dry eye syndrome, and chalazion as well as blepharitis and conjunctivitis) are more prevalent among Koreans with rosacea. Clinicians should proactively check ocular symptoms in rosacea and employ joint care with an ophthalmologist in cases of need.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.); (J.D.L.)
| | - Minah Cho
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.); (J.D.L.)
| | - Hyun Jeong Ju
- Department of Dermatology, St. Vincent’s Hospital, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jung Min Bae
- Heal House Skin Clinic, Mesanro 24, Paldal-gu, Suwon 16461, Korea;
| | - Sang Hyun Cho
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.); (J.D.L.)
| | - Jeong Deuk Lee
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.); (J.D.L.)
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.); (J.D.L.)
- Correspondence: ; Tel.: +82-32-280-5100
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Reinhold A, Janeschitz-Kriegl L, Traber G, Baston AE, Scholl H, Gatzioufas Z. [Spontaneous Corneal Perforation in Vernal Keratoconjunctivitis-Associated Keratopathy in a Young Patient]. Klin Monbl Augenheilkd 2021; 238:367-368. [PMID: 33930912 DOI: 10.1055/a-1425-6766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wladis EJ, Arunachalam T, LaJoie JE, Lau KW, Adam AP. Myeloid differentiation factor 88 expression in eyelid specimens of rosacea. Orbit 2021; 41:329-334. [PMID: 33789561 DOI: 10.1080/01676830.2021.1905668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Rosacea is a common cause of ocular surface disease. Specific immunologic features have been implicated in its pathogenesis, including toll-like receptors, mitogen-associated kinase, and nuclear factor kappa-B. Myeolid differentiation factor 88 (MYD88) has been associated with these elements, suggesting a role for this protein in rosacea. This study was designed to compare the expression of MYD88 in the eyelids of patients with and without this disease.Methods: Western blotting for MYD88 was performed in 14 control patients and 15 patients with rosacea. Bands were quantified and normalized to actin. Immunohistochemical staining for MYD88 was performed in a different cohort of 12 patients with rosacea and 12 controls, and positively-staining cells were counted across five consecutive 40x fields. Statistical analyses compared the differences between the two groups via a dedicated software package.Results: On western blotting, the mean ratios of MYD88 to actin were 13.8 (standard deviation = 14.1) and 44.3 (standard deviation = 39.6) in control and rosacea patients, respectively (p = .002). On immunohistochemistry, the mean numbers of positively-staining cells were 12.1/40x field (standard deviation = 9.61/40x field) and 27.4/40x (standard deviation = 18.7/40x field) in control and rosacea patients, respectively (p = .0438).Conclusions: MYD88 is enriched in eyelid specimens of rosacea. This finding further implicates the innate immune system in the pathogenesis of rosacea, and is consistent with previous reports regarding the role of this protein in ocular surface disease and the previously-implicated cellular features of the disease. Inhibition of MYD88 may be a successful treatment strategy to manage rosacea.
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Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College, Lions Eye Institute, Albany, New York, USA
| | - Thilaka Arunachalam
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College, Lions Eye Institute, Albany, New York, USA
| | - Juliann E LaJoie
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College, Lions Eye Institute, Albany, New York, USA
| | - Kevin W Lau
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College, Lions Eye Institute, Albany, New York, USA
| | - Alejandro P Adam
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical College, Lions Eye Institute, Albany, New York, USA.,Center for Molecular Physiology, Albany Medical College, Albany, New York, USA
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Kwok SS, Wong FSY, Shih KC, Chan YK, Bu Y, Chan TCY, Ng ALK, Lo ACY, Tong L, Yam GHF, Jhanji V. Lycium barbarum Polysaccharide Suppresses Expression of Fibrotic Proteins in Primary Human Corneal Fibroblasts. J Clin Med 2020; 9:jcm9113572. [PMID: 33171906 PMCID: PMC7694544 DOI: 10.3390/jcm9113572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023] Open
Abstract
(1) Objective: To study the anti-fibrotic effects of Lycium barbarum polysaccharides (LBP) on corneal stromal fibroblasts and assess LBP’s effect on cell viability. (2) Methods: Primary human corneal keratocytes of passage 3 to 6 were used for all experiments. Cells are pretreated with LBP solution for 24 h and then transforming growth factor beta 1 (TGFβ1) for 48 h and collected for experiments. Fibrotic protein analysis was performed using immunofluorescence and Western blot. The effect of LBP on cell viability was assessed using the MTS assay. (3) Results: LBP significantly reduced the expression of fibrotic proteins, including α-SMA and extracellular matrix proteins (collagen type I and III). LBP significantly decreased the viability of myofibroblasts but not the fibroblasts. Conclusions: In this study, LBP was effective in the prevention of fibrosis gene expression. Further studies to assess the underlying mechanism and pharmacological properties will facilitate the formation of a topical LBP solution for in vivo studies.
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Affiliation(s)
- Sum Sum Kwok
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Francisca Siu-Yin Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
- Correspondence:
| | - Yau-Kei Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Yashan Bu
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Tommy Chung-Yan Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Alex Lap-Ki Ng
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Amy Cheuk-Yin Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong and Hong Kong SAR, Hong Kong, China; (S.S.K.); (F.S.-Y.W.); (Y.-K.C.); (Y.B.); (T.C.-Y.C.); (A.L.-K.N.); (A.C.-Y.L.)
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Centre, Singapore 168751, Singapore;
- Ocular Surface Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore
| | - Gary Hin-Fai Yam
- Department of Ophthalmology, University of Pittsburgh Medical Centre, Pittsburgh, PA 15213, USA; (G.H.-F.Y.); (V.J.)
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Centre, Pittsburgh, PA 15213, USA; (G.H.-F.Y.); (V.J.)
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Gomez-Elizondo DE, Lopez-Martinez M, Ruiz-Lozano RE, Valdez-Garcia JE, Hernandez-Camarena JC. Corneal perforation associated with isolated ocular lichen planus: a case report. Eur J Ophthalmol 2020; 31:NP9-NP12. [PMID: 32493062 DOI: 10.1177/1120672120932089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To report a case of unilateral corneal perforation due to isolated ocular lichen planus. METHODS Interventional case report. Informed consent by the patient was obtained to publish clinical images. A 64-year-old male presented with severe vision loss and a 2-week history of corneal perforation treated with penetrating keratoplasty in the left eye. He had a longstanding diagnosis of severe chronic dry eye disease. On the initial assessment a visual acuity of 20/50 in the RE and HM perception in the left eye were documented. Biomicroscopy revealed subepithelial fibrosis on the tarsal conjunctiva and clinical signs of severe dry eye disease in both eyes. A clear corneal button and a white cataract were observed in the left eye. No other skin or mucosal lesions were observed. RESULTS An excisional biopsy of the bulbar conjunctiva was performed under topical anesthesia. Direct immunofluorescence analysis revealed a linear deposit of fibrinogen in the basement membrane consistent with ocular lichen planus. Clinical improvement was achieved using aggressive topical lubrication, corneal epithelial regenerators, topical tacrolimus, and immunosuppressive therapy with systemic corticosteroids and cyclophosphamide. CONCLUSION Isolated ocular lichen planus is an extremely infrequent presentation of lichen planus often indistinguishable from other cicatricial conjunctivitis. Corneal perforation is a severe complication associated with severe dry eye, not previously reported with ocular lichen planus. An adequate clinical assessment and histopathologic diagnosis are crucial to lead prompt treatment and prevent sight-threatening complications.
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Affiliation(s)
| | | | | | - Jorge E Valdez-Garcia
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
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Donmez O, Akova YA. Pediatric Ocular Acne Rosacea: Clinical Features and Long Term Follow-Up of Sixteen Cases. Ocul Immunol Inflamm 2019; 29:57-65. [PMID: 31647686 DOI: 10.1080/09273948.2019.1668951] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: To report the clinical characteristics, treatment modalities and long term follow-up of 16 pediatric ocular acne rosacea patients.Methods: The medical records of pediatric ocular acne rosacea patients were reviewed.Results: There were 16 patients with a mean age of 7.7 ± 5 (1-16) years. The mean follow-up period was 52.8 ± 52 (3-150) months. Eight patients had skin involvement. The mean duration of delay for diagnosis was 16.2 ± 5.1 (4-48) months. Nine patients had a delayed diagnosis. Meibomitis, blepharitis, lid telangiectasia, and conjunctival hyperemia were present in all cases. Systemic antibiotics were prescribed in 12 patients. The mean delay in diagnosis was longer in patients with conjunctival/corneal involvement (p = .001) and these patients required longer systemic treatment (p = .001). Complete remission was achieved in 87.5% of cases.Conclusion: Children presenting with a long history of ocular irritation, meibomian gland disease, recurrent chalazia and peripheral corneal infiltrates should alert ophthalmologists to consider the diagnosis of ocular acne rosacea even in the absence of skin changes.
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Affiliation(s)
- Oya Donmez
- Department of Ophthalmology, Bayindir Kavaklidere Hospital, Ankara, Turkey
| | - Yonca Aydın Akova
- Department of Ophthalmology, Bayindir Kavaklidere Hospital, Ankara, Turkey
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12
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Wladis EJ, Lau KW, Adam AP. Nuclear Factor Kappa-B Is Enriched in Eyelid Specimens of Rosacea: Implications for Pathogenesis and Therapy. Am J Ophthalmol 2019; 201:72-81. [PMID: 30703356 DOI: 10.1016/j.ajo.2019.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the role of nuclear factor kappa-B (NFKB) in cutaneous specimens of rosacea and unaffected tissue. METHODS Immunohistochemical staining was performed for the activated, phosphorylated variant of NFKB (pNFKB) in eyelid specimens of rosacea (n = 12) and normal, healthy tissue (n = 12). The numbers of positively staining cells/40× microscopic field were counted across 5 consecutive fields. Additionally, quantitative Western blotting was carried out for pNFKB and NFKB in specimens of rosacea (n = 15) and normal controls (n = 14). Statistical comparisons were performed via a dedicated software package. RESULTS The mean number of cells/40× microscopic field that stained positively for pNFKB was 18.4 (standard deviation = 15.3) for control patients and 39.3 (standard deviation = 16.9) for rosacea patients, and the difference between the 2 groups was statistically significant (P = .0024). On Western blotting, the mean ratios of pNFKB:NFKB for control and rosacea patients measured 0.58 (standard deviation = 0.81) and 3.11 (standard deviation = 3.53), respectively. The 2 groups were statistically significantly different (P = .0002). CONCLUSIONS The activated form of NFKB is enriched in rosacea, indicating a role for this pathway in the pathogenesis of this disease. Interference with NFKB signaling may represent a novel therapy for rosacea as clinical agents become available. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Al-Balbeesi AO, Almukhadeb EA, Halawani MR, Bin Saif GA, Al Mansouri SM. Manifestations of ocular rosacea in females with dark skin types. Saudi J Ophthalmol 2019; 33:135-141. [PMID: 31384155 PMCID: PMC6664278 DOI: 10.1016/j.sjopt.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 11/28/2022] Open
Abstract
Background Current knowledge about ocular rosacea in dark skin individuals is lacking. The prevalence of ocular rosacea varies considerably among studies and is probably higher than previously presumed. Objective To estimate the prevalence and pattern of ocular rosacea among dark skinned female patients, compare it with fair skinned, and to correlate the severity of cutaneous disease with ocular findings. Method Female patients diagnosed with rosacea between 2011 and 2013 were studied prospectively. They were referred to ophthalmology for clinical observations and slit lamp examination. In all patients Schirmer and Tear break up time tests to diagnose dry eye were performed. Result Fifty six consecutive female patients, joined the study with different skin types ranging from skin type 4 to 6. A total of 43 patients (76.8%) were positive for ophthalmologic findings. The most frequent symptoms were itching, burning sensation and redness, while the most frequent signs were meibomian gland dysfunction, dry eyes, eyelid telangiectasia and irregular margin. Significant correlation was noted between meibomian gland dysfunction and irregular lid margin (P = 0.003). Dry eye and Schirmer test significantly correlated with eye lid telangiectasia (p = 0.004; 0.015) respectively. No significant correlation was found between the severity of cutaneous disease and ocular findings. Conclusion Ocular rosacea in dark skinned females is a common presentation and is comparable to that reported for fair skin, with eyelid telangiectasia and meibomian gland dysfunction being early phenomena. Earlier onset and more benign course were seen compared to other studies. Ocular and cutaneous rosacea are independent of each other.
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Affiliation(s)
- Amal O Al-Balbeesi
- Department of Dermatology (82), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Eman A Almukhadeb
- Department of Dermatology (82), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mona R Halawani
- Department of Dermatology (82), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bin Saif
- Department of Dermatology (82), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Samir M Al Mansouri
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Trufanov SV, Shakhbazyan NP. [Ophthalmic Rosacea: etiopathogenesis and modern treatment methods]. Vestn Oftalmol 2018; 134:121-128. [PMID: 29953092 DOI: 10.17116/oftalma20181343121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Rosacea is a multifactorial chronic inflammatory disease with various clinical manifestations. Primarily it is seen as a dermatological condition, but it's not uncommon for it to develop ophthalmological implications affecting eyelids, cornea and conjunctiva. The article describes main aspects of its etiopathogenesis, variations in its clinical course and treatment approaches. There is currently no universal treatment strategy for the disease due to its varying clinical manifestation, particularly of its ophthalmological form, differing severity of the pathological process, lack of knowledge about its etiology and pathogenesis. Leading role in its pathological process belongs to disturbance of regulatory mechanisms of the vascular, immune and nervous systems. Additionally, higher levels of metalloproteinases and vascular endothelial growth factor (VEGF) can be observed. Possible influence of a range of micro-organisms also hasn't been excluded. Basic therapy involves both systemic and topical drugs. The first include tetracycline antibiotics. A new direction in Rosacea treatment that aims at structural and functional restoration of vascular endothelium, improvement of microcirculation and recovery of rheological properties of blood is angioprotector therapy, in particular with Calcium Dobesilate (Doxi-Hem). Aside from systemic drugs, the ophthalmological forms of Rosacea are treated topically with anti-inflammatory preparations, immunosuppressants and artificial tears that are chosen depending on the symptoms' severity. In cases with heavy corneal damage, various types of keratoplasty can be performed. Collaboration between ophthalmology and dermatology specialists is necessary in order to choose adequate strategy for Rosacea treatment.
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Affiliation(s)
- S V Trufanov
- Research Institute of Eye Diseases, 11A, В Rossolimo St., Moscow, Russian Federation, 119021
| | - N P Shakhbazyan
- Research Institute of Eye Diseases, 11A, В Rossolimo St., Moscow, Russian Federation, 119021
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15
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Treatment of ocular rosacea. Surv Ophthalmol 2018; 63:340-346. [DOI: 10.1016/j.survophthal.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
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16
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Longo CM, Adam AP, Wladis EJ. Rosacea and the eye: a recent review. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1429268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christine M. Longo
- Department of Regenerative and Cancer Cell Biology, MC-165, Albany Medical College, Albany, NY, USA
| | - Alejandro P. Adam
- Department of Molecular and Cellular Physiology, MC-8, Albany Medical College, Lions Eye Institute, Albany, NY, USA
- Department of Ophthalmology, Albany Medical College, Albany, NY, USA
| | - Edward J. Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Albany, NY, USA
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17
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Ocular Rosacea Causing Corneal Melt in an African American Patient and a Hispanic Patient. Case Rep Ophthalmol Med 2017; 2017:2834031. [PMID: 29158934 PMCID: PMC5660782 DOI: 10.1155/2017/2834031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/10/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To discuss two rare presentations of ocular rosacea in a Hispanic patient and an African American patient with unusual ocular manifestations. Case Report Case 1: a 43-year-old Hispanic woman presented with right eye corneal perforation. Her prior medical history was significant for rosacea only, diagnosed clinically by a dermatologist. Her eye exam showed signs of bilateral ocular rosacea. An emergent full thickness tectonic corneal patch graft was done. The patient's bilateral eye symptoms improved one month after initiating rosacea treatment. Case 2: a 51-year-old African American man with long standing history of untreated rosacea presented with bilateral peripheral corneal thinning with neovascularization that led to right eye corneal perforation. Glue and bandage contact lens were applied. The patient did well 4 weeks after starting antibacterial, oral steroids, and rosacea treatment. Discussion Ocular rosacea can present in Hispanic and African American patients with severe manifestations such as corneal perforation.
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Liang H, Randon M, Michee S, Tahiri R, Labbe A, Baudouin C. In vivo confocal microscopy evaluation of ocular and cutaneous alterations in patients with rosacea. Br J Ophthalmol 2016; 101:268-274. [PMID: 27222243 DOI: 10.1136/bjophthalmol-2015-308110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/15/2016] [Accepted: 04/23/2016] [Indexed: 11/04/2022]
Abstract
AIMS The physiopathology of rosacea and the correlation between ocular and cutaneous rosacea remains unclear. This study analysed ocular and cutaneous rosacea with in vivo confocal microscopy (IVCM). METHODS Thirty-four eyes of 34 patients with confirmed rosacea-associated meibomian gland dysfunction-related evaporative dry eye were enrolled in the study. The ophthalmological investigations included dry eye ocular surface disease index (OSDI), the Schirmer test, tear osmolarity, tear break up time, the Oxford score, infrared meibography for meibomian gland (MG) analysis and IVCM investigation for cornea, MG and skin analysis (cheek, hand). Presences of Demodex in the MG and in the cheek were also investigated. We established scores for quantifying the MG alterations in the MG (IVCM-MG) and cheek (IVCM-Cheek), and scores for Demodex quantification in the MG and cheek (IVCM-MG-Dex and IVCM-Cheek-Dex). RESULTS IVCM was relevant for analysing the cornea and MG structures and was also suitable for cutaneous analysis. Exposed skin explorations presented the epidermal and dermal layers clearly. In patients with rosacea, the IVCM-MG alteration scores were correlated with IVCM-Cheek (R2=0.27 and p=0.0006) and IVCM-MG-Dex was correlated with IVCM-Cheek-Dex (R2=0.70 and p<0.0001). However, no correlation was found between the IVCM-MG or IVCM-Cheek and the break up time, Schirmer, Oxford and osmolarity evaluations. CONCLUSIONS IVCM could be a safe, effective and reliable tool to quantify alterations of the cornea, MG and cheek glands in patients with rosacea combined with quantification of Demodex infections. As a valuable tool for investigating the pathophysiology of the disease, it could be used to assess the effectiveness of therapy.
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Affiliation(s)
- Hong Liang
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,INSERM, U968, Paris, France.,UMR S 968, Institut de la Vision, UPMC University Paris 06, Paris, France.,CNRS, UMR 7210, Paris, France
| | - Matthieu Randon
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Sylvain Michee
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Rachid Tahiri
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Antoine Labbe
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,INSERM, U968, Paris, France.,UMR S 968, Institut de la Vision, UPMC University Paris 06, Paris, France.,CNRS, UMR 7210, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, APHP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Christophe Baudouin
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,DHU View Maintain, INSERM-DHOS, Center of Clinical Investigations (CIC) 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,INSERM, U968, Paris, France.,UMR S 968, Institut de la Vision, UPMC University Paris 06, Paris, France.,CNRS, UMR 7210, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, APHP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
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Asai Y, Tan J, Baibergenova A, Barankin B, Cochrane CL, Humphrey S, Lynde CW, Marcoux D, Poulin Y, Rivers JK, Sapijaszko M, Sibbald RG, Toole J, Ulmer M, Zip C. Canadian Clinical Practice Guidelines for Rosacea. J Cutan Med Surg 2016; 20:432-45. [PMID: 27207355 DOI: 10.1177/1203475416650427] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations.
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Affiliation(s)
- Yuka Asai
- Division of Dermatology, Queen's University, Kingston, ON, Canada
| | - Jerry Tan
- University of Western Ontario, Windsor, ON, Canada
| | | | | | | | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Danielle Marcoux
- CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Jason K Rivers
- Bearing Biomedical Consulting, Vancouver, BC, Canada Pacific DermAesthetics, Vancouver, BC, Canada
| | - Mariusz Sapijaszko
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - John Toole
- University of Manitoba, Winnipeg, MB, Canada
| | - Marcie Ulmer
- Bearing Biomedical Consulting, Vancouver, BC, Canada Carruthers & Humphrey, Vancouver, BC, Canada
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21
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Kılıç Müftüoğlu İ, Aydın Akova Y. Clinical Findings, Follow-up and Treatment Results in Patients with Ocular Rosacea. Turk J Ophthalmol 2016; 46:1-6. [PMID: 27800249 PMCID: PMC5076302 DOI: 10.4274/tjo.48902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 04/07/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives: To report the clinical features, treatment options and complications in patients with ocular rosacea. Materials and Methods: The records of 48 eyes of 24 patients with ocular rosacea were retrospectively reviewed. Patients’ ocular signs and symptoms were scored between 1 and 4 points according to disease severity; tear film break-up time (BUT) and Schirmer’s test results were recorded before and after the treatment. Preservative-free artificial tears, topical antibiotic eye drops/ointments, short-term topical corticosteroids, topical 0.05% cyclosporine and oral doxycycline treatment were applied as a standard therapy to all patients. Additional treatments were given as needed. Complications were recorded. Results: Twenty-four patients with a mean age of 48.5±35.4 (32-54) years were followed for a mean 15±9.4 (8-36) months. Ocular findings included meibomitis in 100% of cases, anterior blepharitis in 83% (40 eyes), punctate keratopathy in 67% (32 eyes), chalazia in 50% (24 eyes), corneal neovascularization in 50% (24 eyes) and subepithelial infiltrates in 16.6% (8 eyes). Significant improvement of symptoms and clinical findings were achieved in all patients with treatment. The increases in Schirmer’s test and BUT were 3.3±1.5 and 4.5±2.8, respectively (p<0.05). Descemetocele and small corneal perforation occurred in 2 eyes; re-epithelialization was achieved in both eyes with tissue adhesive application (1 eye) and additional amniotic membrane transplantation (1 eye). Four eyes of three patients showed significant regression of corneal neovascularization with topical bevacizumab therapy. Conclusion: Ocular rosacea may present with a variety of ophthalmic signs. It is possible to control the ophthalmic disease with appropriate therapeutic modalities including topical corticosteroids, topical cyclosporine and systemic doxycycline.
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Nivenius E, Montan P. Spontaneous corneal perforation associated with atopic keratoconjunctivitis: a case series and literature review. Acta Ophthalmol 2015; 93:383-7. [PMID: 25682856 DOI: 10.1111/aos.12617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 10/31/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe spontaneous corneal perforations in patients with atopic keratoconjunctivitis. METHODS Records of patients with atopic keratoconjunctivitis and spontaneous corneal perforation seen by the authors were reviewed. A literature search of corneal complications in atopic keratoconjunctivitis and predisposing factors for spontaneous corneal perforations in corneal ectasias was undertaken. RESULTS Three patients with seven incidents of corneal perforation were identified and presented. Corneal thinning and keratoconus are observed at a higher rate in patients with atopic keratoconjunctivitis, and severe ocular allergy has been reported as a risk factor for corneal hydrops. CONCLUSIONS Atopic keratoconjunctivitis appears to be a risk factor for spontaneous sterile corneal perforation. Corneal thinning and keratoconus in addition to inflammatory changes of the cornea in these patients probably predispose to the corneal melt in these perforations. A close observation of the fellow eye of affected patients is important and systemic immunosuppressive therapy should be considered.
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Affiliation(s)
- Emma Nivenius
- Division of Ophthalmology and Vision; Department of Clinical Neuroscience; Karolinska Institutet; St. Erik's Eye Hospital; Stockholm Sweden
| | - Per Montan
- Division of Ophthalmology and Vision; Department of Clinical Neuroscience; Karolinska Institutet; St. Erik's Eye Hospital; Stockholm Sweden
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Awais M, Anwar MI, Iftikhar R, Iqbal Z, Shehzad N, Akbar B. Rosacea – the ophthalmic perspective. Cutan Ocul Toxicol 2014; 34:161-6. [DOI: 10.3109/15569527.2014.930749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vieira AC, Mannis MJ. Ocular rosacea: common and commonly missed. J Am Acad Dermatol 2014; 69:S36-41. [PMID: 24229635 DOI: 10.1016/j.jaad.2013.04.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 04/21/2013] [Indexed: 12/23/2022]
Abstract
Rosacea is a prevalent disorder that may be disfiguring and cause significant ocular morbidity, if not diagnosed and managed appropriately. Ocular rosacea, in particular, is often left undiagnosed as no specific test is available to confirm the diagnosis. Accurate diagnosis is further complicated because symptoms of ocular rosacea are not always specific to the disorder alone. Other ophthalmic disorders may present with similar findings. Further challenges exist because the severity of ocular symptoms is often not related to the severity of cutaneous findings in rosacea. Isolating a disease marker may facilitate earlier diagnosis and treatment, and could also contribute to better understanding of disease pathogenesis. The glycomics of tear fluid and saliva in patients with rosacea shows promise as an initial step in the search for a biomarker specific to the disease. We have previously found potentially important disease biomarkers in roseatic tear and saliva samples. Further investigation should prove important in the early stages of developing a set of markers for accurate disease identification.
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Central corneal thickness in patients with mild to moderate rosacea. Can J Ophthalmol 2012; 47:504-8. [DOI: 10.1016/j.jcjo.2012.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/22/2012] [Accepted: 07/27/2012] [Indexed: 12/17/2022]
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