< Current issue
Dermatopathology: Practical & Conceptual July - September 2008
7. Hypothesis: The pathogenesis of rosacea keratitis
Almut Böer, M.D.
Review of the literature
It is well known that rosacea often affects not only the skin of the face, but also the eye. In current textbooks of dermatology and dermatopathology, no clear concept about the pathogenetic link between both manifestations of the disease is provided.
(1) To review all that is currently published about rosacea of the eye; (2) To clarify terms basic to the subject; (3) To integrate all in clinicopathologic correlation.
Review of articles about rosacea with special emphasis on studies about rosacea of the eye.
Few studies on bigger groups of patients with rosacea of the eye are available, most in the literature of ophthalmology. From all studies available it seems that as a consequence of inflammation in and around infundibula of the eyelashes as well as of the infundibula-like funnels that connect meibomian glands with the lid margin, the lipid layer of the tear film decreases, which facilitates evaporation of the watery tear film. This is followed by a broken tear film and the clinical finding of a "dry eye" (so-called sicca syndrome). Ulceration of the cornea ("keratitis") in rosacea develops only consequent to the broken tear film and is accompanied always by conjunctivitis. If keratitis develops, patients also will complain about photophobia and in time, vision will be impaired.
The pathologic process of rosacea on the face, namely, infundibulitis and peri-infundibulitis, is the very same that accounts for rosacea of the eyelid, where it affects infundibula-like funnels of meibomian glands and infundibula of eyelashes followed by an impaired contribution of meibomian and Zeiss glands to the stability of the tear film. Everything else that may develop in the eyes of patients with rosacea is consequent to a reduced lipid layer of the tear film, an end pathway that rosacea has in common with many other conditions that cause a "dry eye."
Almut Böer is a dermatopathologist at the Dermatologikum Hamburg. This article was reviewed by Friederike Kauer, M.D., and Diana Alvarez, M.D. Contact author via e-mail:
This site is made possible in part by:
Copyright © Derm101.com. All Rights Reserved.