Lecture 7 - Multifactorial Disorders of the Orbit and Adnexa

What is rosacea?

Idiopathic disorder of the sebaceous glands.

What is the etiology of rosacea?

Unknown.

What climatic factor may contribute to rosacea?

Climatic exposures.

What dermal factor may contribute to rosacea?

Dermal matrix degeneration.

What chemical-related factor may contribute to rosacea?

Chemicals and ingested agents.

What structural abnormality may contribute to rosacea?

Pilosebaceous unit abnormalities.

What microorganism is associated with rosacea?

Demodex.

What iron-storage protein expression may contribute to rosacea?

Ferritin expression.

What oxidative factor may contribute to rosacea?

Reactive oxygen species.

What vascular factor may contribute to rosacea?

Increased neoangiogenesis.

What immune-related dysfunction may contribute to rosacea?

Dysfunction of antimicrobial peptides.

What facial areas are commonly affected by rosacea?

Forehead, cheeks, chin, nose, and eyelids.

In which patient populations is rosacea more common?

Older patients, women, and those with fair skin of Northern European descent (Irish, Welsh, Scottish).

What is the characteristic appearance of the cheeks in rosacea?

Flushed or blushed cheeks.

What is erythema?

Chronic blood vessel dilation and inflammation.

What is telangiectasis?

Small permanently dilated blood vessels.

What type of skin eruption is commonly seen in rosacea?

Inflammatory papulopustular eruptions resembling acne vulgaris.

What skin changes may occur in progressive rosacea?

Thickening and coarsening of the skin with enlarged pores.

What is rhinophyma?

Progressive enlargement and thickening of the nose due to rosacea.

In which sex is rhinophyma more common?

Men much more commonly than women.

What type of reaction is rhinophyma?

A phymatous reaction.

Is it common for patients to present with only one subtype of rosacea?

No, most patients have multiple subtypes and isolated presentation is rare.

What characterizes erythematotelangiectatic rosacea?

Facial flushing and persistent redness.

What characterizes papulopustular rosacea?

Bumps, pimples, and raised red patches.

What characterizes phymatous rosacea?

Enlargement of the nose (rhinophyma).

What characterizes ocular rosacea?

Eye irritation.

Which patients are more commonly affected by ocular rosacea?

Middle-aged women, although men can also be affected; less common in children.

What type of blepharitis is associated with ocular rosacea?

Chronic, relentless blepharitis.

What dry eye symptom is associated with ocular rosacea?

Dry eyes.

What foreign body sensation symptom is associated with ocular rosacea?

Grittiness.

What light sensitivity symptom is associated with ocular rosacea?

Photophobia.

What burning symptom is associated with ocular rosacea?

Ocular burning.

What lid margin finding is commonly seen in ocular rosacea?

Thickened lid margins.

What meibomian gland finding is commonly seen in ocular rosacea?

Meibomian stasis.

What gland dysfunction is associated with ocular rosacea?

Meibomian gland dysfunction (MGD).

What conjunctival conditions may occur with ocular rosacea?

Conjunctivitis or conjunctival injection.

What eyelid lesions may occur with ocular rosacea?

Hordeola and chalazia.

What lacrimal drainage condition may occur with ocular rosacea?

Canaliculitis.

What corneal vascular complication may occur with ocular rosacea?

Superficial or deep corneal neovascularization.

What corneal inflammatory complication may occur with ocular rosacea?

Stromal infiltrate.

What is the first step in management of rosacea?

Recognize and avoid exacerbating triggers.

What beverages should patients with rosacea avoid?

Hot drinks such as coffee, tea, and soup.

What specific drink should patients with rosacea avoid?

Alcohol.

What food-related trigger should patients with rosacea avoid?

Spicy foods.

What UV-related environmental trigger should patients with rosacea avoid?

Excessive UV exposure.

What temperature-related environmental trigger should patients with rosacea avoid?

Excessive heat.

What drug-related environmental trigger should patients with rosacea avoid?

Smoking.

What psychological trigger should patients with rosacea avoid?

Stress.

What basic eyelid treatment is recommended for ocular rosacea?

Warm compresses and eyelid hygiene.

Which systemic antibiotic class is commonly used for ocular rosacea?

Tetracycline derivatives.

In which patients are tetracycline derivatives contraindicated?

Pregnant patients, nursing patients, and children younger than 8 years.

What counseling should be given to patients taking tetracyclines?

Educate about phototoxicity and instruct them to take the medication on an empty stomach to ensure absorption.

What is the initial tetracycline dosing regimen for ocular rosacea?

Tetracycline 250 mg four times daily for 2 weeks, then daily, then taper slowly.

What is the maintenance dose of tetracycline for ocular rosacea?

250 mg once daily.

What is the initial doxycycline dosing regimen for ocular rosacea?

Doxycycline 100 mg twice daily for 2 weeks, then daily, then taper slowly.

What is the maintenance dose of doxycycline for ocular rosacea?

40-100 mg once daily.

What antibiotic can be used if tetracyclines are contraindicated?

Erythromycin 250 mg four times daily.

What topical antibiotic is used as an adjuvant to systemic therapy for rosacea blepharitis?

Topical metronidazole.

What topical immunomodulator can be used for chronic rosacea-related ocular and eyelid inflammation?

Topical 0.05% cyclosporine twice daily.

Are topical corticosteroids recommended for rosacea?

No, topical corticosteroids are contraindicated.

Are systemic corticosteroids recommended for rosacea?

No, systemic corticosteroids are contraindicated.

What topical medication is used for facial lesion erythema in rosacea?

Mirvaso (brimonidine 0.33% topical gel).

What type of drug is brimonidine?

A glaucoma drug.

What receptor class does brimonidine act on?

Alpha-2 adrenergic receptor agonist.

How does brimonidine improve facial erythema?

It induces vasoconstriction.

What light-based therapy can be used for rosacea?

Intense pulsed light (IPL) therapy.

Besides rosacea, what other ocular condition is IPL used to treat?

Dry eye disease.

How does IPL help in rosacea-related ocular disease?

It calms inflammation, warms glands, liquefies hardened meibum, and reduces bacteria and mites.

How does IPL affect abnormal eyelid blood vessels?

It reduces abnormal blood vessels and constricts telangiectatic vessels on the eyelids.

What procedural treatments can be used for rosacea skin changes?

Chemical peels, electrosurgery, CO₂ laser, or dermabrasion.

What hygiene measure should be maintained in rosacea management?

Lid hygiene.

What meibomian gland condition should be addressed in rosacea management?

Meibomian gland dysfunction (MGD).

What parasitic infestation should be addressed in rosacea management?

Demodex infestation.

What supportive treatment provides symptomatic relief in ocular rosacea?

Lubrication with artificial tears.

Why should topical steroids be avoided in ocular rosacea?

They can cause rebound inflammation.

How do topical steroids affect immune defenses in ocular rosacea?

They reduce immune response to pathogens and can alter the eyelid microbiome.

How do topical steroids affect wound healing?

They delay wound healing.

What serious corneal complication can occur with topical steroid use in ocular rosacea?

Corneal perforation.

What should be done regarding the underlying disease process in ocular rosacea?

Treat the underlying condition as discussed.

When should dermatology consultation be obtained for rosacea?

When warranted.

What eyelid changes may require surgery in rosacea?

Cicatricial lid changes.