The Role Of The Dermatologist In The Treatment Of Ophthalmosocacea

Increase the effectiveness of detection, differential diagnosis and avoidance of the wrong approach in the treatment of dermatological manifestations of ophthalmosacea, which have clinical similarities with other nosologies using the example of a clinical case.

A 30 y.o. woman with complaints about: feeling of dryness of the lips, nose, eyes, blurred vision, hyperemia of the eyelids. Has an active skin process for many years. In the area of the cheeks, nose and chin there are swollen papules, pustules, on the background of erythematous skin - couperosis, numerous closed painful comedones, telangiectasias. Maceration of the eyelids in the corners, edema, the presence of crusts on the marginal edge of the eyelids, telangiectasias.

The dermatologist made a diagnosis: Acne. Oily seborrhea. Peeling of the skin of the face was performed. Sent for further examination. According to the results, a concomitant diagnosis was established: Adrenal hyperandrogenism. Iron deficiency anemia. Deficiency of selenium, iodine. Prescribed: isotretinoin, antiandrogens, iron, iodine, selenium preparations, skin care. The condition of the skin of the face improved, but there were complaints about the feeling of "sand" in the eyes, blurring of the image, which was not the case before. The dermatologist prescribed anti-allergic drops, but it did not improve, so the patient came to the department of eye diseases for a consultation.

Visual acuity was 0.8 in both eyes, with correction: sph +0.25=1.0. The eyelids are hyperemic, the edges are thickened, deformed, with telangiectasias. The lacrimal meniscus don't cover Marx's line. The mouths of the meibomian glands with signs of necrosis. Type 2 on the LIPCOF scale. Сonjunctival injection, spot staining with fluorescein dye. Cornea: edema of the epithelium within the widened eye slit, pannus. The epithelium looks like "foggy glass". The diagnosis was established: Ophthalmorozacea. Dry eye disease. Dry keratoconjunctivitis. Treatment is prescribed: eyelid massage , eyelid hygiene, gel for eyelids, moisturizing eye drops with trehalose. After the treatment, the condition of the tears, conjunctiva and cornea has normalized. 

Cooperation between dermatologists and ophthalmologists in the management of patients with symptoms common to many nosologies is important. It will help to avoid the wrong approach in treatment and to minimize the number of side effects from the prescribed therapy. Ophthalmorosacea can manifest as a combination of three other forms of rosacea in the periorbital area. The skin and tissues around the eyes can be involved in all types of rosacea. Inflammation can lead to meibomian gland dysfunction and dry eye symptoms. Therefore, it is necessary to use a combined approach in the treatment of ophthalmosacea, depending on the clinical picture and manifestations in each individual case.