Recognizing Paediatric Ocular Rosacea: Clinical Spectrum, Diagnostic Clues, and Treatment Outcomes.

PURPOSE: To evaluate demographic and clinical characteristics, diagnostic clues, and treatment outcomes among paediatric patients with ocular rosacea. METHODS: Medical records of patients aged ≤ 16 years diagnosed with ocular rosacea between 2020 and 2026 were retrospectively reviewed. Demographic characteristics, presenting symptoms, eyelid and corneal findings, dermatological involvement, diagnostic delay, treatment response, recurrence, and follow-up outcomes were recorded. Disease severity at the initial examination and after treatment was evaluated using the clinical severity score described by Audelan et al. graded on a 0-4 scale. RESULTS: Thirty-one patients with 62 eyes were included. The female-to-male ratio was 22/9, and the mean age was 7.7 ± 4.6 (1-16) years. The most common presenting symptom was burning and/or stinging (58.1%). Blepharitis was the most common eyelid manifestation (98.4%). Corneal and dermatologic involvement were observed in 71.0% of eyes and 54.8% of patients, respectively. The mean interval between symptom onset and diagnosis was 13.2 ± 12.1(20 days-36 months) months. Three patients (9.7%) had previously been treated as having herpetic keratitis. Mean follow-up duration was 10.2 ± 10.7 (1-36) months. The mean clinical severity score decreased significantly from 2.52 ± 1.16 to 1.34 ± 1.39 after treatment (p < 0.001), with improvement in 47 eyes (75.8%). No recurrence was documented during follow-up period. CONCLUSION: Paediatric ocular rosacea is an underrecognized ocular surface disease with a broad clinical spectrum and often a delayed diagnosis. A standardized clinical severity score may provide a common language for grading and monitoring. Early recognition and appropriate long-term management may help reduce morbidity.