SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

Information for Patients

View all Images (13)

Rosacea - External and Internal Eye
See also in: Overview,Cellulitis DDx
Other Resources UpToDate PubMed

Rosacea - External and Internal Eye

See also in: Overview,Cellulitis DDx
Contributors: Kimberley R. Zakka MD, MSc, Lauren Strazzula MD, Susan Burgin MD, Harvey A. Brown MD
Other Resources UpToDate PubMed


Rosacea is a common, chronic inflammatory condition with a relapsing-remitting course. It presents with facial flushing and localized erythema, telangiectases, papules, and pustules on the nose, cheeks, brow, and chin. It commonly develops in individuals between the ages of 30 and 50, but it can occur at any age.

The etiology of rosacea is incompletely understood but likely involves dysregulation of immune and neurocutaneous mechanisms. Cutaneous vascular changes, ultraviolet (UV) and microbial exposure (ie, Demodex mites, Bacillus oleronius, and Staphylococcus epidermidis), and disruption of the epidermal barrier have all been implicated as playing a role in the pathogenesis in this condition. There have been reports of familial rosacea, so an underlying genetic predisposition has not been ruled out. In fact, rosacea has been found to be associated with single nucleotide polymorphisms in genes coding for major histocompatibility complex (MHC).

Rosacea primarily affects individuals with lighter skin phototypes, namely those of northern European and Celtic descent. In individuals with darker skin colors, rosacea may be underdiagnosed due to difficulty in discerning erythema and telangiectasias. Rosacea has been found to have no sex predilection, in contrast to previous studies noting a female predominance.

According to the American National Rosacea Society, there are 4 main subtypes of the disease: erythematotelangiectatic, papulopustular, phymatous, and ocular rosacea.
  1. Erythematotelangiectatic rosacea – Presents with persistent erythema of the central portion of the face with intermittent flushing. Telangiectasias are present in most individuals. Patients often mention stinging or burning sensations on the skin. This is the most common subtype.
  2. Papulopustular rosacea – Presents with variable intensity of central facial erythema with relative sparing of the periocular areas and a variable number of acneiform papules and pustules. Dramatic swelling can result in lymphedematous changes manifesting as solid facial edema or lead to phymatous changes.
  3. Phymatous rosacea – Chronic inflammation and edema result in marked thickening of the skin with sebaceous hyperplasia, resulting in an enlarged, cobblestoned appearance of affected skin, most commonly on the nose (rhinophyma). Men are more often affected. Less commonly, phymatous rosacea can affect the ears (otophyma), chin (gnatophyma), forehead (metophyma), or eyelids (blepharophyma).
  4. Ocular rosacea – Symptoms of mild ocular rosacea include gritty sensation, dryness, tearing, and itching of the eyes. Styes occur frequently. More active ocular rosacea can present as blepharitis, lid margin telangiectasia, and conjunctival injection.
A granulomatous variant has also been defined and is characterized by papules, nodules, and yellow-brown pustules distributed on the central face, eyelids, forehead, cheeks, nasolabial folds, and periocular and perioral regions. It is often described as noninflammatory and may be unilateral. Flushing is less common. Other disease manifestations include rosacea fulminans (pyoderma faciale), which refers to the sudden onset of inflammatory facial papules and pustules with possible abscess formation, and Morbihan disease (solid facial edema).

Patients can present with characteristics of more than one subtype. More than half of patients with rosacea present with ocular symptoms.

Diagnostic criteria for rosacea were ratified in 2017 by the global ROSacea Consensus (ROSCO) panel and subsequently approved by the American National Rosacea Society. Two features were identified as being independently diagnostic for rosacea: phymatous changes and persistent centrofacial erythema with periodic intensification by potential trigger factors. In their absence, 2 or more major features and some minor features can be used to establish the diagnosis. Major features are flushing / transient centrofacial erythema, telangiectasia, inflammatory papules / pustules, and ocular manifestations. Minor features are burning, stinging, and dry sensation of the face and edema.

Since rosacea manifests on the face, it is important to recognize that this disease can have psychosocial consequences, which may affect quality of life and social and psychological wellbeing.


L71.9 – Rosacea, unspecified

398909004 – Rosacea

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Subscription Required


Subscription Required

Last Reviewed:02/15/2022
Last Updated:05/11/2022
Copyright © 2024 VisualDx®. All rights reserved.
Patient Information for Rosacea - External and Internal Eye
Print E-Mail Images (13)
Contributors: Medical staff writer
Premium Feature
VisualDx Patient Handouts
Available in the Elite package
  • Improve treatment compliance
  • Reduce after-hours questions
  • Increase patient engagement and satisfaction
  • Written in clear, easy-to-understand language. No confusing jargon.
  • Available in English and Spanish
  • Print out or email directly to your patient
Copyright © 2024 VisualDx®. All rights reserved.
Rosacea - External and Internal Eye
See also in: Overview,Cellulitis DDx
A medical illustration showing key findings of Rosacea (Erythematotelangiectatic) : Erythema, Nose, Cheeks, Telangiectasias
Clinical image of Rosacea - imageId=331974. Click to open in gallery.  caption: 'Erythema, telangiectasias, and few scattered inflammatory papules on the cheek.'
Erythema, telangiectasias, and few scattered inflammatory papules on the cheek.
Copyright © 2024 VisualDx®. All rights reserved.