Photo Rounds

Diminished vision and face papules

A 30-year-old woman went to her family physician (FP) for treatment of papules and pustules that had been on her face for the past 5 years and had diminished her vision in both eyes. She said that her eyes always felt dry and irritated.

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The FP diagnosed papulopustular rosacea in this patient, along with ocular rosacea. The patient had advanced ocular rosacea with neovascularization on the cornea, which can lead to blindness.

Ocular rosacea is an advanced subtype of rosacea that is characterized by impressive, severe flushing with persistent telangiectasias, papules, and pustules. Patients may complain of watery eyes, a foreign-body sensation, burning, dryness, vision changes, and lid or periocular erythema. The eyelids are most commonly involved with telangiectasias, blepharitis, and recurrent hordeola and chalazia. Conjunctivitis may be chronic. Although corneal involvement is the least common, it can have the most devastating consequences. Corneal findings may include punctate erosions, corneal infiltrates, and corneal neovascularization. In the most severe cases, blood vessels may grow over the cornea and lead to blindness.

The FP in this case started the patient on oral doxycycline 100 mg twice a day and made an urgent referral to Ophthalmology. At a follow-up visit one month later, the FP noted that the patient had been started on ophthalmic cyclosporine for the ocular rosacea. The doxycycline had diminished the papules and pustules, and together with the ophthalmic cyclosporine, the patient’s eyes were feeling less symptomatic. The ophthalmologist also indicated that the patient might need corneal transplants in the future if medical treatment did not stop the severe corneal involvement.

Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Rosacea. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:659-664.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

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