Severe Pediatric Ocular Surface Disease: Multimodal Approach and Treatment

Background/Objectives: Pediatric ocular surface disease associated with ocular rosacea, chronic blepharitis and meibomian gland dysfunction may result in significant corneal morbidity. In refractory cases, the limitations of conventional therapy have stimulated interest in adjunctive treatment modalities, including intense pulsed light (IPL) therapy. Methods: We report the case of a 10-year-old female patient with cutaneous rosacea, recurrent chalazia and chronic blepharitis who was referred for specialized ocular surface evaluation due to persistent ocular surface disease despite previous treatment. Results: At presentation, slit-lamp examination revealed diffuse keratitis, eyelid telangiectasia, inferior corneal neovascularization and corneal scarring. Despite the severity of ocular surface findings, no significant ocular complaints were documented and the OSDI-12 score was low. Ocular surface analysis demonstrated reduced non-invasive tear break-up time, incomplete blink rate, reduced lipid layer thickness and decreased tear meniscus height. Following optimization of conventional therapy, IPL treatment and adjunctive warming massage mask therapy, early improvement was observed in several ocular surface parameters, together with reduction of eyelid inflammation, improvement of keratitis and partial regression of corneal neovascularization. Subsequent longitudinal measurements showed variability. Conclusions: Pediatric ocular surface disease may present with severe objective findings despite minimal subjective symptoms, potentially delaying diagnosis and treatment. Careful evaluation is therefore essential in children with recurrent chalazia and chronic blepharitis. A multimodal therapeutic approach was associated with clinical and objective improvement in this patient; however, the contribution of individual treatment components cannot be established from a single case.