Eyeworld

84 | EYEWORLD | APRIL 2022 C ORNEA by Ellen Stodola Editorial Co-Director About the physicians Albert Cheung, MD Virginia Eye Consultants Norfolk, Virginia Vincent de Luise, MD Assistant Clinical Professor of Ophthalmology Yale University School of Medicine New Haven, Connecticut Henry Perry, MD Chief of the Cornea Service NuHealth Medical Center East Meadow, New York In order to diagnose, Dr. Cheung said it helps to take a step back and look at facial features. Close examination of the eyelids at the slit lamp is also important, noting the presence of telangiectasias and hyperemia, presence of meibomian gland expression with pressure, quality of meibum, and presence of inspissation. Dr. Cheung added that there may be chalazia/ hordeola or history of these. Fluorescein can help highlight the previously mentioned corneal findings and lissamine green the conjunctival changes. This issue is more common in women and among patients middle-aged or older, Dr. Cheung said. Rosacea can flare up in response to certain triggers such as sun exposure or emotional stress, Dr. de Luise said. He said that a newer, updated classification of rosacea by the American Academy of Derma- tology is now by phenotype. "Using a targeted therapy for each of these phenotypes/subtypes is now the preferred strategy of care by derma- tologists," he said. 1 Impact of oculocutaneous rosacea on the ocular surface Dr. de Luise discussed the corneal and ocular surface manifestations of ocular rosacea, which he described as protean and including anterior blepharitis, posterior blepharitis (mei- bomitis and meibomian gland dysfunction), eyelid telangiectasias, madarosis, punctate R osacea can be a significant problem for many patients and may be more prevalent than physicians think. De- pending on the subtype, there may be ocular involvement. Albert Cheung, MD, Vincent de Luise, MD, and Henry Perry, MD, discussed treatment strategies, in addition to sharing what to look for and how to diagnose. Signs of oculocutaneous rosacea and diagnosis Dr. Perry said rosacea is a chronic disease that usually starts when patients are in their 20s or 30s. It's a disease that has a fairly high preva- lence, up to 10% in some parts of the country. He added that diagnosis is mainly one of inspec- tion by people who have treated the disease for a long time or have it themselves. Many patients have the disease and aren't aware of it. There are four types of rosacea, but usually we think of it being vascular or inflammatory, Dr. Perry said. For ophthalmologists, the most important part of rosacea is ocular rosacea, Dr. Perry said, but the other three are important as well be- cause 50% of patients in those groups also have ocular symptoms. These include erythemato- telangiectatic rosacea, papulopustular rosacea, and phymatous rosacea. Erythematotelangiectatic rosacea is a common form where there is scaling of the skin usually in the central face. Patients may have a tendency to flush, which can be exacerbated by cold, heat, alcohol, or sunlight. Papulopustular rosacea usually occurs in the central face and may look like acne vulgaris. Phymatous rosacea is commonly identified by a large bulbous nose and is caused by proliferation of vessels, hyper- trophy of sebaceous glands, and thickening skin. Dr. Cheung said that cutaneous signs in- clude erythema/flushing, papules and pustules, telangiectasias, and rhinophyma. While ocular symptoms are often related to burning, itching, redness, and foreign body sensation, the most common signs are meibomian gland dysfunction and blepharitis. "These patients can also have conjunctival injection, phlyctenules, and kerati- tis, ranging from superficial punctate keratitis to marginal infiltrates and ulceration." Signs of rosacea and how to treat Rosacea keratitis; spade-like peripheral infiltrates and peripheral keratoconjunctivitis

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