Pediatric Ocular Rosacea Presenting As Recurrent Bilateral Keratitis : A Diagnostic Challenge

To report a case of pediatric ocular rosacea presenting as recurrent bilateral keratitis initially misdiagnosed as herpetic keratitis, and to emphasize the importance of early recognition to prevent corneal complications.

Ophthalmology Department, Public Hospital Hakim Okbi. Guelma.

Case report of a 10-year-old girl followed for two years for recurrent keratitis episodes occurring approximately every six months. Initial diagnosis was presumed herpetic keratitis and antiviral therapy (aciclovir) was prescribed without significant clinical improvement. A detailed eyelid and ocular surface examination was subsequently performed.

Clinical examination revealed marked inflammatory keratitis in the left eye and milder corneal involvement in the right eye. Bilateral conjunctival hyperemia and chronic blepharitis with signs of meibomian gland dysfunction were observed. No dendritic epithelial lesions were present. The absence of response to antiviral therapy suggested a non-herpetic inflammatory etiology. Treatment with topical corticosteroids using slow tapering, combined with topical azithromycin and eyelid hygiene, resulted in significant improvement. Recurrence frequency decreased under maintenance management. No visually significant corneal scarring was noted at last follow-up.

Pediatric ocular rosacea is an under-recognized cause of recurrent bilateral keratitis and may mimic herpetic disease. Careful evaluation of eyelid inflammation and ocular surface findings is essential. Early anti-inflammatory therapy and long-term blepharitis management are crucial to prevent recurrences and potential corneal sequelae.