Pediatric Ocular Rosacea: Clinical Features and Long-Term Maintenance Therapy with Topical Cyclosporine

To evaluate the clinical presentations, visual outcomes, meibography, and non-invasive tear break-up time (NIBUT) findings in pediatric ocular rosacea (OR) patients receiving maintenance therapy with topical cyclosporine. This retrospective study reviewed medical records of patients under 16 years diagnosed with OR. Demographic characteristics, corneal involvement, delayed diagnosis, and recurrence rates were assessed. Best-corrected visual acuity (BCVA), cylindrical value, meibography findings, and NIBUT were evaluated at presentation and the final visit. During the acute phase, all patients received artificial tear, topical antibiotic, topical steroid, and systemic azithromycin. For maintenance therapy, topical 0.05% cyclosporine drops were used. There were 22 patients with a mean age of 7.6 ± 3.4 years. The mean follow-up time was 23.8 ± 9.9 months. Seven patients had skin involvement. Corneal involvement with was present in 20 out of 22 patients. Delayed diagnosis was present in 10 patients, with a mean delay duration of 10.0 ± 2.7 months. Two patients showed recurrence and mean recurrence time was 6.50 ± 2.50 months. The BCVA of eyes with poorer vision improved compared to the initial presentation (0.34 ± 0.27 logMAR) at the last visit (0.02 ± 0.04 logMAR). The cylindrical value of the eyes with poorer vision decreased at the last visit (−2.21 ± 1.33 D) compared to baseline. The rate of MG loss in both upper and lower eyelids decreased with treatment and NIBUT improved. This retrospective case series suggests that long-term maintenance therapy with topical cyclosporine, improves visual outcomes, reduces ocular surface inflammation and stabilizes the tear film in pediatric patients with OR.