Severity of Eye Involvement May Be Connected to Cutaneous Symptoms of Rosacea

Observing that ocular involvement is common among patients with rosacea, researchers have published their recent findings that also suggest a possible connection between the severity of ocular involvement and certain cutaneous symptoms.

Findings were published in Turkish Journal of Ophthalmology.

The researchers analyzed 102 eyes of 51 patients, finding that nearly three-fourths (74.5%) of patients demonstrated signs of ocular involvement, in line with previous findings. Signs of ocular involvement included lid margin erythema and telangiectasias; anterior blepharitis and meibomian gland dysfunction; styes and chalazia; corneal erosion, vascularization, and thinning; scleritis and sclerokeratitis.

Among the 38 patients with ocular signs, the most commonly observed signs were lid margin erythema (100%), meibomian gland dysfunction (94.7%), and blepharitis (73.7%). There were 15 patients who had diminished eye function from rosacea-related complications, including leukoma and corneal neovascularization, 3 (7.9%) of which required keratoplasty.

Notably, the researchers found that among the patients with the weakest eye function resulting from rosacea corneal involvement, there was a significant association with rhinophyma, papules, and pustules.

“As it has been mentioned before, rosacea manifests with relapses and remissions. Special attention should be given to ocular involvement during exacerbations, as progression of skin disease could lead to more severe ocular damage. Early referral to the ophthalmologist in these cases might prevent visual loss,” posited the researchers

They further noted that there is no gold standard for diagnosing ocular involvement in rosacea and every patient may have some level of ocular compromise.

Among the patients included in the study, most were women, and the average age of presentation was 50 years.

Treatments for the patients included in the study comprised artificial tears (65.8%), oral doxycycline (60.5%), corticosteroid-antibiotic ointment (57.9%), and lid hygiene (39.5%). Close to 8.0% required a corneal transplant, resulting from decreased visual acuity.

“We identified 2 cases of associated OCP [ocular cicatricial pemphigoid] in patients with ocular rosacea. This suggests that these 2 diseases can coexist. OCP is an autoimmune disease that involves a type 2 hypersensitivity reaction,” wrote the researchers. “Both environmental factors and genetic susceptibility might be involved in loss of tolerance to the components of the basement membrane zone. As has been proposed for other diseases that may coexist with OCP, ocular surface injuries related to rosacea could expose basement membrane epitopes of damaged conjunctiva, which might act as neoantigens that precipitate the autoimmune response.”

Reference

Saá F, Cremona F, Chiaradia P. Association between skin findings and ocular signs in rosacea. Turk J Ophthalmol. 2021;51(6):338-343. doi:10.4274/tjo.galenos.2021.05031