A 43-year-old Hispanic woman presented with recurrent asymmetrical bilateral eye redness, tearing, and pain for the past 2 years, with more severe symptoms in the right eye. Her ocular history was negative prior to this presentation. Her past medical history is significant only for rosacea, diagnosed clinically more than ten years ago by a dermatologist. She denied illicit drug use, exposure to patients with tuberculosis, or promiscuous sexual activity. Her family history is negative for ocular diseases and for autoimmune diseases. Aside from her eyes and her skin complaints, her review of systems was negative. Her right eye visual acuity was 20/40 and intraocular pressure was 8 mm Hg. Right eye slit lamp exam showed iris plugging a perforated cornea superonasally with associated extensive neovascularization (Figure 1) and a shallow but formed anterior chamber (Figure 2).
The cornea in her left eye appeared normal. Signs of bilateral blepharitis due to ocular rosacea such as eyelid telangiectasias, thick meibomian gland secretions with digital compression, and collarettes on the base of upper and lower eyelashes were present. The patient consented to an emergent, full thickness, tectonic corneal patch graft. Postoperative management consisted of topical steroid (prednisolone acetate ophthalmic solution 1%) every two hours that was tapered slowly after one-week period and topical moxifloxacin four times daily for a total period of two weeks. Concurrently a dermatologist initiated rosacea treatment consisting of minocycline 100 mg orally twice daily and benzoyl peroxide/erythromycin gel daily. At week one after grafting, the visual acuity was 20/100 (Figure 3).
The patient's bilateral eye signs and symptoms improved significantly one month after initiating rosacea treatment.