Reversible Blindness: A Case Of Ocular Rosacea In A Child

To report a case of severe ocular rosacea in a child, managed with topical azithromycin 1.5% and eyelid hygiene. 

Department of Ophthalmology, Habib Thameur University Hospital, Tunis, Tunisia.

The medical records of a nine-year-old girl referred to our ophthalmology department for a keratoplasty, were reviewed.  Careful medical history, evaluation of best-corrected visual acuity (BCVA), slit-lamp examination, anterior segment photographs and anterior segment optical coherence tomography (AS-OCT) were performed. 

A nine-year-old girl presented with blurred vision and photophobia in the right eye (RE). Ophthalmologic examination of the RE noted a BCVA of 1/20, an opacified cornea and 360 degrees of neovascularization. AS-OCT of the RE showed a diffuse stromal hyperreflectivity. Left eye examination was unremarkable. The diagnosis of ocular rosacea was made, with absence of cutaneous signs. Combined therapy of eyelid hygiene, lubricating agents, azithromycin 1.5% eye drops and topical steroids led to a progressive improvement of the clinical signs. Two months later, BCVA was 20/20 with a significant decrease of central corneal opacification and neovascularization. A gradual tapering of topical steroids associated to close follow-ups were indicated. 

Ocular rosacea in children is often underdiagnosed, due to the variety of its clinical presentations and the frequent absence of typical cutaneous signs. But given the potential severity of this condition leading to severe decrease of visual acuity, it is important for ophthalmologists to keep this diagnosis in mind in order for timely treatment to be instituted. Appropriate management including eyelid hygiene and azithromycin 1.5% eye drops have proven to be efficient in preserving visual function and preventing amblyopia.