Rosacea keratitis (RK)
Rosacea is a skin condition causing red facial skin and her skin changes. Rosacea keratitis occurs when the condition affects the surface of the eye itself, the cornea.
It consists of eyelid changes (a type of blepharitis) and corneal changes.
All RK patients have blepharitis (Blepharitis is the medical term for inflamed eyelids). The inflammation is like eczema of the skin, with red, scaly eyelids. You may notice tired, or gritty eyes, which may be uncomfortable in sunlight or a smoky atmosphere. They may be slightly red, and feel as though there is something in them. The eyelids have tiny glands in them, especially the lower lids. These glands make substances that mix with tears, and help the tears to spread across the eye. There may be fungi in the lids Eye 15, or demodex mite.
The glands in the eyelids shown in purple
This thin layer of tears lubricates the eyes, stops them drying out, and keeps them comfortable.
Evenly spreading tears: a comfortable eye
Poorly spreading tears: dry patches develop on the surface of the eyes making them sore.
However, as you get older, and particularly if you have dry skin, these glands can block. As a result the glands do not make the chemicals that enables the tears to spread evenly across the front of the eye. As a result, the tears break up, and dry patches develop develop on the surface of the eye. These patches make the eyes feel sore or gritty.
Rosacea keratitis/ ocular rosacea / Blepharokeratoconjunctivitis
In this condition additional changes occur.
- Ocular rosacea (which is probably the same as blepharo-keratoconjunctivitis) may occur in adults or children.
- The condition is often unilateral, and often the skin normal, and there is often a long delay getting treatment.
- (in other patients there may be typical facial rosacea)
- The eyelid margin may not be inflamed,
- but the eyelids may be inflamed ...anterior or posterior
- The condition may be may be asymptomatic (the patient may think theses is nothing wrong, but the doctor sees the eye changes)
- There may be chalazia..lumps in the eyelid.
- There may be styes...the bacteria staphylococcus contributes.
- On the eyelids there is crusting, telangiectasia, phlyctentules, papillary hyperplasia, hyperaemia
- There is keratitis (involvement of the cornea)
- corneal ...crystal, marginal infiltrates, punctate epitheliopathy, axial corneal scars, vascularisation, phlyctenules, thinning, superficial keratitis, leukomas, pinpoint perforations
- The treatment is aimed at first treating the blepharitis: Blepharitis treatment NHS
- Lid cleaning
- Unblocking the glands in the eyelid, which may be infected and inflamed, like acne on the face or a tiny boil by lid cleaning .
- Soak a tissue in hot water (not hot enough to burn), and press it against the upper and lower eyelids. This helps to unblock the glands. Bathe the eyelids for 5 minutes. The bottom lid is easier to bathe and usually the most important to clean. Blephaclean wipes are now the most effective way of cleaning the eyelids. (Available with or without prescription from pharmacies.)
There may be in infection of the eyelid with an invisible mite demodex. It is likely this is killed by ointments such as VitApos. Even with treatment your eyes may remain a little sore, but no harm will come to them and there is nothing to worry about.
- 5 minutes bathing the eyelids, upper and lower, with a tissue soaked in hot water (not hot enough to burn), gently wiping or massaging them. Repeat this at least twice a day for a few days, then twice a week.
Ask your clinic nurse to show you this procedure.
The more effective bathing method is with Hot eye compresses: Meibopatch available on prescription). Some people find these heated masks very helpful, use for 5 minutes twice daily.
- It may take two weeks for any improvement. It is safe to stop cleaning, but you may need to start again if the condition returns.
- (a typical patient)
- 4 times a day for a week
- 3 times a day for a week
- 2 times a day for a week
- once a day for a months
- alternate days for some time
- steroids contribute to cataract; more importantly they cause a pressure rise in 1/8 , so the pressure must be taken after 2 weeks and 2 months and if used long term
- Blepharo-keratoconjunctivitis (Bkc) is probably childhood rosacea
- Red eyes, photophobia, discharge, rubbing, watering, pain
- +/-Asian, age 3-5, unilateral, multiple recurrences
- lid, blepharitis, chalazia, styes, folliculitis
- Styes = bkc not allergic
- Hyperaemia, papillary, phlycten, (no follicles with allergy)
- Corneal, marginal, pee (punctate epithelial erosions), subepithelial lesions
- Brisk improvement with steroids
- Why is this not allergic.... no other atopy, chalazia, follicles, pattern of keratopathy,
- Occasional hsv keratitis
Treatment for children (after Tuft 2015)
- Eye 16 JEADV 17
- Topical antibiotic such as Occ chloramphenicol or Occ azithromycin
- Long term azithromycin may help
- for the lids consider Occ metronidazole.
- Healthy diet
- flaxseed oil 2g/day for 6 weeks, then alternate days for 6 months
- lid cleaning
- Systemic treatment
- Topical steroid
- If steroids drops are used, check eye pressure
- corneal involvement: dexamethasone preservative free 0.1% frequently but reducing quickly
- Topical tacrolimus (Protopic 0.03% twice a day) in addition for severe corneal involvement (or steroid sparing).
- Average 2y treatment, 12% treatment failure
- superficial keratitis
- corneal vascularisation