Pediatric ocular rosacea, a misdiagnosed disease with high morbidity: Proposed diagnostic criteria

Table 1 Different ocular findings in pediatric ocular rosacea[1-8,10-19]

Eyelid: Telangiectasias and erythema of the lid margin, meibomian gland dysfunction, anterior blepharitis, recurrent chalazia/hordeola, madarosis (loss of eyelashes), trichiasis

Conjunctiva: Interpalpebral or diffuse hyperemia, papillary and/or follicular reaction, pinguecula, scarring

Cornea: Punctate erosions, pannus, superficial neovascularization, lipid deposition, spade-shaped infiltrate, scarring, thinning, ulceration, perforation, phlyctenula

Sclera: Episcleritis, scleritis

Insufficiency of tear film (dry eye) with abnormal Schirmer test

Uvea: Iritis (rare)

Table 2 Differential diagnosis of pediatric ocular rosacea[2-4,8,17]

Chronic conjunctivitis	Medication toxicity
(viral, allergic, atopic)	Interstitial keratitis
Keratoconjunctivitis sicca	Infectious keratitis
Meibomitis	(herpes simplex)
Recurrent hordeola/chalazia	Sterile or bacterial corneal ulcers
Staphylococcal blepharoconjunctivitis	Auto-immune diseases
Seborrheic blepharoconjunctivitis	Sarcoidosis

Table 3 Proposed diagnostic criteria of Coimbra for pediatric ocular rosacea

Chronic or recurrent1 keratoconjunctivitis and/or red eye and/or photophobia

Chronic or recurrent1 blepharitis and/or hordeola/chalazia

Eyelid telangiectasia documented by an ophthalmologist

Primary features of pediatric rosacea (facial convex areas with chronic flushing and/or erythema and/or telangiectasia, and/or papule, pustules in cheeks, chin, nose or central forehead and/or primary periorificial dermatitis)

Positive familial history of cutaneous and/or ocular rosacea

Diagnosis: ≥ 3 criteria;

¹Chronic (≥ 2 mo); Recurrent (≥ 3 episodes lasting > 4 wk in 12 mo).