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Papulopustular rosacea — SCE Dermatology MCQ

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HardGeneral dermatology & dermatology in primary health carePapulopustular rosaceaSCE Dermatology

A patient with rosacea develops unilateral ocular pain, photophobia, reduced acuity and corneal haze despite lid hygiene. What is the priority?

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Correct answer: C — Arrange urgent ophthalmic assessment for keratitis or corneal involvement

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E

B is correct. Ocular rosacea commonly causes blepharitis, dryness and irritation, but pain, photophobia, visual reduction or corneal opacity are red flags for keratitis, ulceration or other sight-threatening involvement. These require urgent ophthalmic assessment rather than escalation of cutaneous treatment alone. Brimonidine is for persistent facial erythema, not the lid margin. Isotretinoin can worsen ocular surface dryness and is not started blindly in this setting. Empirical repeated antibiotics can delay diagnosis and do not treat sterile corneal inflammation or structural damage.

Reference: BAD guideline for rosacea: https://doi.org/10.1111/bjd.20485