Pediatric ocular acne rosacea:: Long-term treatment with systemic antibiotics

PURPOSE: To report our experience with four cases of pediatric ocular acne rosacea, including responses to long-term systemic treatment. DESIGN: Retrospective interventional case series. METHODS: The medical records of four consecutive cases diagnosed with pediatric ocular acne rosacea over a period of 36 months were reviewed. Diagnostic criteria were meibomian gland dysfunction, blepharitis, lid mar, gin telangiectasia, punctate superficial keratopathy, and conjunctival hyperemia with or without inferior corneal vascularization. RESULTS: The patients, aged between four and 12, were all females with bilateral disease. Meibomitis, blepharitis, conjunctival hyperemia, and punctuate epitheliopathy was evident in each case. Cutaneous involvement was seen in two cases (50%), and limbal vascularization with subepithelial or stromal infiltrates was present in three cases (75%). One case showed corneal ulceration at presentation. All four children received systemic doxycycline or erythromycin for at least 12 months and showed considerable improvement within the first month of therapy. No recurrence was noted within the mean 25.5 months of follow,up. None of the girls experienced any side effects during the long treatment duration. CONCLUSIONS: Ophthalmologists should consider acne rosacea as a potential diagnosis for any child who has any combination of meibomian disease, chronic blepharitis, recurrent chalazia, and chronic symptoms of photophobia, ocular irritation, and redness that does not respond to routine medical treatment. Such patients respond very well to long-term treatment with systemic erythromycin/ doxycycline.