Patient With Rosacea And Severe Keratoconjunctivitis, Treatment With Amniotic Membrane Transplantation

To remember the possible ocular surface alterations in relation to cutaneous rosacea, as well as the different therapeutic possibilities.

Two cases of patients with cutaneous rosacea presenting severe keratoconjunctivitis despite maximum topical treatment

CASE 1: Adult patient with a history of cutaneous rosacea. Under follow-up for severe keratoconjunctivitis in right eye. Presents with BCVA of 0.2 in the right eye, 0.8 in left eye. In treatment with tacrolimus ointment 0.02%/ 12 hours, palpebral cleaning and autologous serum eye drops.

CASE 2: Pediatric patient with a history of Cornelia de Lange syndrome,and cutaneous rosacea. Ophthalmological history of exotropia, nystagmus, hygh myopia and astigmatism with BCVA (Teller) 20/94 right eye and 20/380 left eye.  Presents chronic bilateral severe keratoconjunctivitis that is usually controlled with tacrolimus ointment 0.03% every 12 hours, eyelid cleaning and artificial tears. 

Iconography and slit lamp follow-up is performed.

 

Sometimes, in both cases, it was necessary rescue treatment with topical corticosteroids (dexamethasone) and oral doxycycline, in most cases with good control of the ocular disease but without improvement of visual acuity.

During the last worsening episode, patients present opacification and corneal vascularization affecting the visual axis, with BCVA less than 0.05.

Amniotic membrane transplantation was performed, producing a very significant decrease in fibrosis and corneal vascularization, as well as a significant improvement in visual acuity

Patients with ocular rosacea may present corneal manifestations in a high percentage.

Sometimes the ocular manifestations precede the cutaneous signs, and the disease may not yet be diagnosed.

The management of keratoconjunctivitis consists in control of the ocular surface inflammation. Topical immunomodulators such as cyclosporine or tacrolimus, and sometimes topical corticosteroids and rescue oral tetracyclines are used.

In severe cases, pannus with vascularization may occur, affecting the visual axis with a consequent decrease in visual acuity.

In these cases, amniotic membrane transplantation is a minimally invasive surgical procedure that offers very good results, significantly reducing inflammation of the cornea and ocular surface.