Corneal Findings in Ocular Rosacea

In cutaneous rosacea, corneal involvement is reported to occur in 5-30% of patients in an equal sex distribution.

In contrast, in patients with frank ocular rosacea, the incidence of corneal involvement is between 75 and 85%.

The inferior cornea is the usual site of rosacea keratitis.

Findings may range from mild punctate epithelial keratitis accompanying the blepharoconjunctivitis to corneal vascularization, infiltration, ulceration, and perforation.

In severe cases, peripheral corneal vascularization of the inferior two thirds of the cornea may progress to sterile corneal infiltration, ulceration, and rarely, perforation.

Punctate corneal epithelial breakdown and macro-ulceration in a patient with chronic rosacea keratopathy.

Characteristic, but not necessarily specific, "spade-like" triangular infiltrates with their base at the limbus may develop.

Vascularized peripheral "spade-shaped" corneal infiltrates in chronic ocular rosacea.

The vascularization may progress to the center of the cornea with severe disease and repeated attacks.

Patient with severe active rosacea blepharo-kerato-conjunctivitis. Note the lid inflammation, posterior lamellar disease, interpalpebral conjunctival hyperemia, corneal vascularization and sterile corneal infiltrates.

Decreased visual acuity may result from scarring and surface irregularity in more advanced cases.

Episodes of corneal melting may occur at the sites of infiltrates resulting in perforation.

Episcleritis, scleritis and iritis have also been reported.