Blepharo-keratoconjunctivitis (Rosacea keratitis RK)
Rosacea is a skin condition causing red facial skin and her skin changes. Rosacea keratitis occurs when the condition affects the surface of the eye itself, the cornea.
It consists of eyelid changes (a type of blepharitis) and corneal changes.
All RK patients have blepharitis (Blepharitis is the medical term for inflamed eyelids). The inflammation is like eczema of the skin, with red, scaly eyelids. You may notice tired, or gritty eyes, which may be uncomfortable in sunlight or a smoky atmosphere. They may be slightly red, and feel as though there is something in them. The eyelids have tiny glands in them, especially the lower lids. These glands make substances that mix with tears, and help the tears to spread across the eye. There may be fungi in the lids Eye 15, or demodex mite.
The glands in the eyelids shown in purple
This thin layer of tears lubricates the eyes, stops them drying out, and keeps them comfortable.
Evenly spreading tears: a comfortable eye
Poorly spreading tears: dry patches develop on the surface of the eyes making them sore.
However, as you get older, and particularly if you have dry skin, these glands can block. As a result the glands do not make the chemicals that enables the tears to spread evenly across the front of the eye. As a result, the tears break up, and dry patches develop develop on the surface of the eye. These patches make the eyes feel sore or gritty.
Blepharokeratoconjunctivitis / Rosacea keratitis/ ocular rosacea
In this condition additional changes occur.
- Ocular rosacea (which is probably the same as blepharo-keratoconjunctivitis) may occur in adults or children.
- The condition is often unilateral, and often the skin normal, and there is often a long delay getting treatment.
- (in other patients there may be typical facial rosacea)
- The eyelid margin may not be inflamed,
- but the eyelids may be inflamed ...anterior or posterior
- The condition may be may be asymptomatic (the patient may think theses is nothing wrong, but the doctor sees the eye changes)
- There may be chalazia..lumps in the eyelid.
- There may be styes...the bacteria staphylococcus contributes.
- On the eyelids there is crusting, telangiectasia, phlyctentules, papillary hyperplasia, hyperaemia
- There is keratitis (involvement of the cornea)
- corneal ...crystal, marginal infiltrates, punctate epitheliopathy, axial corneal scars, vascularisation, phlyctenules, thinning, superficial keratitis, leukomas, pinpoint perforations
- The treatment is aimed at first treating the blepharitis: Blepharitis treatment NHS. healthyfocus.org/how-to-kill-demodex-mites/
- Heat compresses and massage twice a day
- Blephaclean or blephasol twice a day
- Preservative free lubricant
- vitaPos night
- The cleaning helps to reduce the number of bacteria in the glands of the lid. This is the same treatment as for blepharitis and reduce all sorts of lid problems.
- Cleaning: clean lids with Blepharaclean wipes (these can be bought or obtained from a doctor's prescription, or if unavailable a cotton bud). Clean the edge of the eyelids (the eyelash edge) with the wipe or wet cotton bud. Gently scrape off the debris moving the wipe/bud side to side. If using a bud, warm tap water is usually quite safe. The Blepharaclean wipes are probably more effective.
- Bathing: warm compresses with an 'Eyebag' hot compress: these can be bought or obtained on prescription, and one lasts a long time (or similar compress, there are may brands). If you don't have a compress or a microwave, use clean face cloth soaked in warm water, as hot as your eyelids can stand. Bath the eye (closed) for 5-10 minutes. Re-warm the cloth if it gets cold. This makes the debris easier to remove, as below.
- massaging: gently pull the low lid down and (using a mirror) gently press on the lid margin moving fingers over the bone under the lid. (see text YouTube video) WIth the upper lid this is much harder ..try to gently press on the upper lid. Repeat this over 30 seconds. Try to express he secretionsin the glands by massaging towards the edge of the lid.
Gently clean with Blepharaclean wipes ( or a cotton bud if unavailable), looking in mirror, pull the lower eyelid down with the index finger of one hand, and gently but firmly wipe the wipe or bud along the edge of the lid to scrape the debris off. With your chin up try the same on the upper lid, but this is harder.
- Replacing the tears if the eyes are dry with Lubricants (dry eyes and blepharitis may occur together). There are many drops, such such as Hyloforte, Hylocare, Clinitas soothe, and others, but they must be preservative free.
- VitApos at night
- 4 times a day for a week
- 3 times a day for a week
- 2 times a day for a week
- once a day for a month
- alternate days for some time
- steroids contribute to cataract; more importantly they cause a pressure rise in 1/8 , so the pressure must be taken after 2 weeks and 2 months and if used long term
This is a type of chronic conjunctivitis in children. Essentially conjunctivitis develops but does not get better with treatment, and there is also a blepharitis. 'Kertitis' is the medical name for disease of the cornea.
- marked follicles/papillae under the upper lid
- limbal oedema...limbitis
- vascularisation of the peripheral cornea
- corneal infiltrates develop
- corneal scars develop
- lots of blepharitis photo
- aggressive disease is unusual but can cause serious problems such as corneal perforation
- Eye 16
Treatment for children (TK for Good Hope 2020)
- Often one eye
- Clean with wipes, various available for purchase from chemist
- Hot bathing with Eyebag or equivalent (material heated to a specific temperature in the microwave)
- Lids must be clean..this is very important. It is important to change lid 'flora'.
- Azithromycin systemically
- twice a day for 3 days of week one,
- repeat first week of each month for 3 months
- Occasionally azithromycin for lids twice a day for 3 days if there is an infection
- Dexamethasone (steroid eye drop) preservative free 4 times a day 3 days then reduce
- Corneal scarring will generally need long term
- Verkazia 4 times a day (this stings for the first few days) or
- Protopic (tacrolimus 0.03%) on lids some must go in eye
- Preservative free lubricant
- Epithelium punctate staining is related to disease activity not dryness, will need some lubricants
- If the cornea not scarred should be able to control most of disease with cleaning and heat after initial treatment, without long term steroids/Cyclosporine/Protopic
- Average 2y treatment, 12% treatment failure
- superficial keratitis
- corneal vascularisation
- there will be occasional flare ups when a short course of steroid drops will be needed