Severe Corneal Involvement Revealing Pediatric Ocular Rosacea: A Prospective Study Of 14 Cases

To analyze severe corneal manifestations revealing pediatric ocular rosacea and to assess anatomical and functional outcomes following standardized medical and surgical management.

Prospective study conducted at a tertiary referral ophthalmology center, Casablanca, Morocco.

Fourteen consecutive children presenting with severe corneal involvement secondary to ocular rosacea were prospectively included. Diagnosis was established clinically after exclusion of infectious and allergic causes. Comprehensive slit-lamp examination with photographic and video documentation was performed. All patients received a standardized therapeutic protocol including intensive eyelid hygiene, cyclic topical azithromycin, lipid-based tear supplementation, adapted topical corticosteroids,  systemic antibiotics in severe forms and cycloplegic optical correction. Surgical management was performed when required.

Corneal involvement was the initial presentation in all cases, predominantly affecting the inferior cornea. Catarrhal infiltrates and corneal neovascularization were observed in 75% of patients. Severe complications occurred in three children, including pre-perforative ulcer (n=1), and corneal perforations (n=2). The pre-perforative ulcer was managed with a therapeutic contact lens, while perforations required either an anterior Lamellar Keratoplasty or biological tissue adhesive. All patients had associated blepharitis with meibomian gland dysfunction and no cutaneous rosacea. Treatment led to regression of inflammation and a mean visual acuity gain of four lines.

Pediatric ocular rosacea may present as severe corneal disease in the absence of dermatologic signs, leading to delayed diagnosis and significant visual risk. Early recognition combined with standardized medical and, when necessary, surgical intervention is essential to preserve corneal integrity and visual function.