Slit-lamp exam reveals round gelatinous white elevations over the superior limbus called Trantas dots, composed predominantly of eosinophils. The corneal involvement may range from superficial punctate keratopathy to macroerosions , plaques or shield-like ulcers. A chronic staphylococcal bleparitis is commonly associated and must be treated. The conjunctiva may have pale and featureless appearance to become hyperemic and chemotic with papillary hypertrophy during exacerbations .In advanced cases, cicatrization and symblepharon can form usually involving the inferior fornices. Keratopathy is the main cause of visual impairement and includes extensive punctate epitheliopathy , persistant epithelial defects, with shield-shaped anterior stromal ulcers and peripheral neovascularization.
Treatment is by steroids , the time- tested immunologic modulators.
Acne rosacea is a common skin disease affecting facial convexities characterized by flushing, persistant erythema and telangiectasia. Ocular features include hyperemic conjunctivitis, posterior blepharitis, recurrent stye and chalazion formation and keratitis. Ocular treatment include topical steroids , fusidic acid and systemic tetracyclin. Tear film deficiency is also seen in sarcoidosis, familial dysautonomia, mucucutaneous syndromes like Stevens-Johnson and cicatricial pemphigoid where there is inflammation and scarring in the conjunctiva, affecting goblet cell secretion of the mucoid layer of the tear film. Few pathogens only are able to produce corneal infection in the presence of intact epithelium.