Manifestations of ocular rosacea in females with dark skin types

Skin Color Representation in Ophthalmology Textbooks

OBJECTIVE

Inadequate diversity in dermatologic images has been associated with diagnostic delays and poorer health outcomes. This underrepresentation of darker skin tones has also been demonstrated across various fields of medicine, including rheumatology, urology, and in the COVID-19 pandemic. The distribution of skin tones has not been examined in educational ophthalmology texts. The authors aimed to quantify the representation of skin tones across three leading ophthalmology textbooks.

METHODS

Two independent investigators utilized the Fitzpatrick's skin phototype scale to code images containing skin as either "light" (Fitz. I-IV) or "dark" (Fitz. V-VI) in three fundamental ophthalmology textbooks: Clinical Ophthalmology (Salmon and Kanski), Ophthalmology (Yanoff and Duker), and the 13 Basic and Clinical Science Course texts by the American Academy of Ophthalmology. Images without discernible skin color were excluded.

RESULTS

Of the 9766 images reviewed, 2305 images met inclusion criteria. The three textbooks combined were found to have 2123 (92.1%) images of light skin tones and 182 images (7.9%) of dark skin tones. When compared to national data that found 12.6% of individuals to have dark skin tones, the proportion of images with darker skin tones in ophthalmology textbooks was statistically significantly lower (χ ² _corr(1, N = 4996) = 211.7, p < 0.001).

CONCLUSIONS

Darker skin tones are statistically significantly underrepresented in textbooks that are central to education of trainees in ophthalmology. Acknowledgement and inclusion of skin tone diversity in ophthalmology educational materials are necessary to ensure that physicians in the field are equipped with the knowledge and training to provide the highest level of care to all patients.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01636-4.

Rosacea and Dry Eye Disease

Ocular rosacea is a chronic potentially sight-threatening inflammatory condition, which can occur in approximately 20% of patients without skin involvement. However, an accurate diagnosis of ocular rosacea has not been defined yet due to its rather nonspecific symptoms and clinical findings. Therefore, this article updates the current recommendations for diagnosis and treatment of ocular rosacea and the previously published consensus recommendations from the ROSCO expert panel on the management of rosacea.

Ocular Comorbidities in Rosacea: A Case-Control Study Based on Seven Institutions

Rosacea is a facial inflammatory dermatosis that is linked with various systemic illnesses. With regards to the eye, rosacea patients have been described to manifest ocular surface changes, such as blepharitis and conjunctivitis. However, studies that examine the association of rosacea with a wider array of ocular diseases are limited. Thus, our aim was to identify the range of ocular comorbidities in the Korean patient population and create a reference data set. A multi-institutional, case-control study was conducted, where 12,936 rosacea patients and an equal number of sex- and age-matched control subjects were extracted over a 12-year period. We were able to discover a notable association between rosacea and blepharitis (adjusted odds ratio (aOR) 3.44; 95% confidence interval, 2.71–4.36, p < 0.001), conjunctivitis (aOR 1.65; 95% CI, 1.50–1.82, p < 0.001), glaucoma (aOR 1.93; 95% CI, 1.70–2.20, p < 0.001), dry eye syndrome (aOR 1.89; 95% CI, 1.70–2.09, p < 0.001), and chalazion (aOR 3.26; 95% CI, 1.41–7.57, p = 0.006) from logistic regression analysis. Female subjects and individuals younger than 50 exclusively showed higher odds for chalazion. Our study suggests that ocular comorbidities (i.e., glaucoma, dry eye syndrome, and chalazion as well as blepharitis and conjunctivitis) are more prevalent among Koreans with rosacea. Clinicians should proactively check ocular symptoms in rosacea and employ joint care with an ophthalmologist in cases of need.

Ocular rosacea

PURPOSE OF REVIEW

To revisit ocular rosacea as an underappreciated condition which can cause permanent blindness if inadequately treated, and to review data supporting improved diagnostic and treatment strategies.

RECENT FINDINGS

Ocular rosacea has an underrecognized prevalence in children and individuals with darker skin tone. Rosacea has several associations with other significant systemic diseases. Variations in local and systemic microbiome, including demodex infestation, may play a role in pathogenesis, severity, and in explaining the different phenotypes of rosacea. The National Rosacea Society Expert Committee established an updated classification system of rosacea in 2017. New treatment algorithms based on these clinical subtypes are suggested.

SUMMARY

With continued advancements in the understanding of the epidemiology and pathogenesis of rosacea, randomized controlled trials specific for ocular rosacea remain lacking. There is overall consensus that rosacea and ocular rosacea require chronic maintenance treatment strategies involving combination topical and systemic therapies.

Pediatric Ocular Acne Rosacea: Clinical Features and Long Term Follow-Up of Sixteen Cases

Purpose: To report the clinical characteristics, treatment modalities and long term follow-up of 16 pediatric ocular acne rosacea patients.Methods: The medical records of pediatric ocular acne rosacea patients were reviewed.Results: There were 16 patients with a mean age of 7.7 ± 5 (1-16) years. The mean follow-up period was 52.8 ± 52 (3-150) months. Eight patients had skin involvement. The mean duration of delay for diagnosis was 16.2 ± 5.1 (4-48) months. Nine patients had a delayed diagnosis. Meibomitis, blepharitis, lid telangiectasia, and conjunctival hyperemia were present in all cases. Systemic antibiotics were prescribed in 12 patients. The mean delay in diagnosis was longer in patients with conjunctival/corneal involvement (p = .001) and these patients required longer systemic treatment (p = .001). Complete remission was achieved in 87.5% of cases.Conclusion: Children presenting with a long history of ocular irritation, meibomian gland disease, recurrent chalazia and peripheral corneal infiltrates should alert ophthalmologists to consider the diagnosis of ocular acne rosacea even in the absence of skin changes.