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World J Dermatol. May 2, 2016; 5(2): 109-114
Published online May 2, 2016. doi: 10.5314/wjd.v5.i2.109
Pediatric ocular rosacea, a misdiagnosed disease with high morbidity: Proposed diagnostic criteria
Cláudia Arriaga, Mariana Domingues, Guilherme Castela, Manuel Salgado
Cláudia Arriaga, Mariana Domingues, Manuel Salgado, Pediatric Rheumatology Unit, Hospital Pediátrico de Coimbra, Centro Hospitalar Universitário de Coimbra, 3030 Coimbra, Portugal
Guilherme Castela, Pediatric Ophthalmology Unit, Hospital Pediátrico de Coimbra, Centro Hospitalar Universitário de Coimbra, 3030 Coimbra, Portugal
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manuel Salgado, MD, Pediatric Rheumatology Unit, Hospital Pediátrico de Coimbra, Centro Hospitalar Universitário de Coimbra, Avenida Dr. Afonso Romão, 3030 Coimbra, Portugal. mbsalgado27@gmail.com
Telephone: +351-914-231560 Fax: +351-239-717216
Received: October 16, 2015
Peer-review started: October 17, 2015
First decision: December 7, 2015
Revised: January 13, 2016
Accepted: January 27, 2016
Article in press: January 29, 2016
Published online: May 2, 2016
Processing time: 191 Days and 12.4 Hours
Abstract

Ocular rosacea is an important and underdiagnosed chronic inflammatory disorder observed in children. A clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola/chalazions and conjunctival/corneal phlyctenules evolving to neovascularization and scarring may occur. Visual impairment and consequent amblyopia are frequent and corneal perforation although rare is the most feared complication. Ocular manifestations usually precede cutaneous lesions. Although few cases of pediatric ocular rosacea (POR) have been reported in the literature, many cases must have been underdiagnosed or misdiagnosed. The delay in diagnosis is greater than one year in the large majority of cases and may lead to serious ocular sequelae. This review aims to highlight the clinical features of POR, its epidemiology, easy diagnosis and effective treatment. We also propose new diagnostic criteria, in which at least three of the five clinical criteria must be present: (1) Chronic or recurrent keratoconjunctivitis and/or red eye and/or photophobia; (2) Chronic or recurrent blepharitis and/or chalazia/hordeola; (3) Eyelid telangiectasia documented by an ophthalmologist; (4) Primary periorificial dermatitis and/or primary features of rosacea; and (5) Positive familial history of cutaneous and/or ocular rosacea.

Keywords: Ocular rosacea; Diagnostic criteria; Demodex folliculorum; Leukoma; Pediatric; Blepharoconjunctivitis; Chalazia

Core tip: Ocular rosacea is a chronic inflammatory disorder with a clinical spectrum ranging from chronic eyelid inflammation, recurrent ocular redness, photophobia and/or hordeola/chalazions and conjunctival/corneal phlyctenules. Although few cases of pediatric ocular rosacea (POR) have been reported in the literature, many cases must have been underdiagnosed or misdiagnosed. This delay in diagnosis may lead to serious ocular sequelae. This review aims to highlight the clinical features of POR, its epidemiology, new diagnostic criteria, treatment and outcomes.