{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T22:28:56Z","timestamp":1788474536588,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background\/Objectives: Rosacea is a chronic inflammatory dermatosis that may involve the eye, causing surface and adnexal damage that can precede cutaneous signs. Detecting subclinical ocular changes is clinically important because early ocular surface dysfunction may be missed on routine examination yet progress to corneal complications, allowing earlier preventive management when identified. We prospectively evaluated subclinical ocular alterations in cutaneous rosacea using a combined, fully non-invasive high-tech imaging workflow\u2014tear film interferometry, infrared meibography, and exploratory retinal optical coherence tomography angiography (OCT-A)\u2014including patients without clinically evident ocular involvement. Methods: Sixteen patients with cutaneous rosacea (mean age 44.3 \u00b1 11.2 years; 4 males, 12 females) were enrolled and divided into: Group 1\u2014rosacea with clinically evident ocular involvement (n = 11); Group 2\u2014rosacea without clinical ocular involvement (n = 5). Six age-matched healthy subjects served as controls (Group 3). All underwent LipiView II\u00ae interferometry and meibography to quantify lipid-layer thickness (LLT, nm) and meibomian gland (MG) loss score (1 = normal\u20134 = severe), plus retinal OCT-A (Optovue Inc., Fremont, CA, USA). ANOVA with post hoc Tukey test assessed inter-group differences. Results: OCT-A showed no significant alterations in superficial or deep retinal plexuses across groups (p &gt; 0.05). Conversely, LLT was significantly reduced in both rosacea groups vs. controls (OD: 45.5 \u00b1 21.4 nm and 67.4 \u00b1 10.1 nm vs. 92.7 \u00b1 8.2 nm; OS: 40.4 \u00b1 15.3 nm and 66.4 \u00b1 10.1 nm vs. 96.0 \u00b1 6.7 nm; p &lt; 0.001). MG score was markedly higher (worse) in rosacea (OD: 3.63 \u00b1 0.50 and 3.20 \u00b1 0.83 vs. 1.83 \u00b1 0.75; OS: 3.45 \u00b1 0.68 and 3.40 \u00b1 0.54 vs. 1.66 \u00b1 0.81; p &lt; 0.001). Ocular symptoms were reported by 85% of patients yet slit-lamp examination revealed surface alterations in 58% of asymptomatic cases. Conclusions: Tear film interferometry and meibography detect early ocular surface impairment in rosacea\u2014even in the absence of clinical signs\u2014while retinal microvasculature appears unaffected. Routine ophthalmologic screening of all rosacea patients could enable prompt treatment of subclinical dysfunction, potentially preventing corneal complications. Retinal OCTA metrics were not significantly different in this small pilot cohort, and these negative findings should be interpreted cautiously pending larger studies.<\/jats:p>","DOI":"10.3390\/diseases14030105","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T13:12:24Z","timestamp":1773321144000},"page":"105","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tear Film Interferometry, Meibography, and Optical Coherence Tomography Angiography for Rosacea"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2969-8610","authenticated-orcid":false,"given":"Matteo","family":"Capobianco","sequence":"first","affiliation":[{"name":"Eye Clinic, Catania University, Policlinico G. Rodolico, 95121 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0999-5545","authenticated-orcid":false,"given":"Marco","family":"Zeppieri","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy"},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6710-2460","authenticated-orcid":false,"given":"Federico","family":"Visalli","sequence":"additional","affiliation":[{"name":"Eye Clinic, Catania University, Policlinico G. Rodolico, 95121 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pellegrini","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, ASFO Pordenone Hospital, 33170 Pordenone, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro","family":"Inferrera","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9755-0786","authenticated-orcid":false,"given":"Rosa","family":"Giglio","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0069-0171","authenticated-orcid":false,"given":"Irene","family":"Gattazzo","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ospedale Sant\u2019Antonio, Azienda Ospedaliera, 35127 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6807-9455","authenticated-orcid":false,"given":"Francesco","family":"Cappellani","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, Piazza dell\u2019Universit\u00e0, 94100 Enna, Italy"},{"name":"Mediterranean Foundation \u201cG.B. Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7938-876X","authenticated-orcid":false,"given":"Fabiana","family":"D\u2019Esposito","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, Piazza dell\u2019Universit\u00e0, 94100 Enna, Italy"},{"name":"Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, London NW1 5QH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-0068","authenticated-orcid":false,"given":"Caterina","family":"Gagliano","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, Piazza dell\u2019Universit\u00e0, 94100 Enna, Italy"},{"name":"Mediterranean Foundation \u201cG.B. Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1111\/bjd.18420","article-title":"Recommendations for rosacea diagnosis, classification and management: Update from the global ROSacea Consensus 2019 panel","volume":"182","author":"Schaller","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jaad.2017.08.037","article-title":"Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee","volume":"78","author":"Gallo","year":"2018","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.12688\/f1000research.16537.1","article-title":"Recent advances in understanding and managing rosacea","volume":"7","author":"Buddenkotte","year":"2018","journal-title":"F1000Research"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/bjd.15122","article-title":"Updating the diagnosis, classification and assessment of rosacea: Recommendations from the global ROSacea Consensus (ROSCO) panel","volume":"176","author":"Tan","year":"2017","journal-title":"Br. J. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"579","DOI":"10.2340\/00015555-2335","article-title":"Facial erythema of rosacea: Aetiology, different pathophysiologies and treatment options","volume":"96","author":"Steinhoff","year":"2016","journal-title":"Acta Derm. Venereol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1590\/S0004-27492012000500016","article-title":"Ocular rosacea: A review","volume":"75","author":"Vieira","year":"2012","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1097\/ICO.0000000000000393","article-title":"Evaluation of dry eye and meibomian gland dysfunction with meibography in patients with rosacea","volume":"34","author":"Palamar","year":"2015","journal-title":"Cornea"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Woo, Y.R., Lim, J.H., Cho, D.H., and Park, H.J. (2016). Rosacea: Molecular mechanisms and management of a chronic cutaneous inflammatory condition. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17091562"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.jaad.2017.03.040","article-title":"Role of Demodex mite infestation in rosacea: Systematic review and meta-analysis","volume":"77","author":"Chang","year":"2017","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/jdv.19954","article-title":"Elevated plasma levels of calcitonin gene-related peptide in individuals with rosacea: A cross-sectional case-control study","volume":"39","author":"Wienholtz","year":"2025","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"261","DOI":"10.5021\/ad.21.223","article-title":"The effect of capsaicin on neuroinflammatory mediators of rosacea","volume":"34","author":"Kim","year":"2022","journal-title":"Ann. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ajo.2021.12.004","article-title":"Clinical, Meibographic, and Interferometric Evaluation in Children with Ocular Rosacea","volume":"237","author":"Martin","year":"2022","journal-title":"Am. J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1097\/ICO.0b013e318191b870","article-title":"Non-invasive measurement of tear-film lipid-layer thickness by interferometry","volume":"28","author":"Blackie","year":"2009","journal-title":"Cornea"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1016\/j.ophtha.2009.04.037","article-title":"Proposed diagnostic criteria for obstructive meibomian gland dysfunction","volume":"116","author":"Itoh","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1007\/s00417-017-3709-7","article-title":"Optical coherence tomography angiography in pre-perimetric open-angle glaucoma","volume":"255","author":"Cennamo","year":"2017","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e4907","DOI":"10.1097\/MD.0000000000004907","article-title":"Optical coherence angiography: A review","volume":"95","author":"Teper","year":"2016","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1002\/jvc2.428","article-title":"Ocular rosacea: The often-overlooked component of rosacea","volume":"3","author":"Geng","year":"2024","journal-title":"JEADV Clin. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"621","DOI":"10.17343\/sdutfd.962200","article-title":"Evaluation of meibomian glands in cutaneous rosacea","volume":"28","author":"Muhafiz","year":"2021","journal-title":"Med. J. SDU"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3109\/15569527.2014.930749","article-title":"Rosacea\u2014The ophthalmic perspective","volume":"34","author":"Awais","year":"2015","journal-title":"Cutan. Ocul. Toxicol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/ICO.0000000000003785","article-title":"Ocular Rosacea: An Updated Review","volume":"44","author":"Navas","year":"2025","journal-title":"Cornea"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.ajo.2025.05.033","article-title":"TFOS DEWS III: Diagnostic Methodology","volume":"279","author":"Wolffsohn","year":"2025","journal-title":"Am. J. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Schmidl, D., Schlatter, A., Chua, J., Tan, B., Garh\u00f6fer, G., and Schmetterer, L. (2020). Novel Approaches for Imaging-Based Diagnosis of Ocular Surface Disease. Diagnostics, 10.","DOI":"10.3390\/diagnostics10080589"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103657","DOI":"10.1016\/j.pdpdt.2023.103657","article-title":"Optical coherence tomography angiography aspects of the retinal and optic disc microvascular morphology in erythemato-telangectatic rosacea","volume":"43","author":"Ay","year":"2023","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lee, B.J.H., Tey, K.Y., Cheong, E.Z.K., Wong, Q.Y., Chua, C.S.Q., and Ang, M. (2024). Anterior Segment Optical Coherence Tomography Angiography: A Review of Applications for the Cornea and Ocular Surface. Medicina, 60.","DOI":"10.20944\/preprints202408.1744.v1"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.ajo.2016.06.025","article-title":"Development of Definitive and Reliable Grading Scales for Meibomian Gland Dysfunction","volume":"169","author":"Arita","year":"2016","journal-title":"Am. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.exer.2017.06.011","article-title":"Ocular surface inflammation impairs structure and function of meibomian gland","volume":"163","author":"Mizoguchi","year":"2017","journal-title":"Exp. Eye Res."},{"key":"ref_27","first-page":"268","article-title":"In vivo confocal microscopy evaluation of ocular and cutaneous alterations in patients with rosacea","volume":"101","author":"Liang","year":"2017","journal-title":"Br. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1080\/09273948.2020.1817496","article-title":"Optical coherence tomography angiography for evaluation of retinal vascular changes in patients with psoriasis according to disease severity","volume":"30","author":"Alkan","year":"2022","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s40942-025-00677-2","article-title":"Assessment of retinal microvascular changes in patients with systemic lupus erythematosus using optical coherence tomography angiography","volume":"11","author":"Basiony","year":"2025","journal-title":"Int. J. Retin. Vitr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S183","DOI":"10.4103\/IJO.IJO_671_23","article-title":"Current application of intense pulsed light for the management of dry eye disease: A systematic review and meta-analysis","volume":"72","author":"Pratomo","year":"2024","journal-title":"Indian J. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.clae.2018.06.002","article-title":"Long term effects of intense pulsed light treatment on the ocular surface in patients with rosacea-associated meibomian gland dysfunction","volume":"41","author":"Seo","year":"2018","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2130","DOI":"10.1080\/09273948.2024.2328791","article-title":"Improvement of Clinical Findings, Meibography and Tear Film Parameters in Pediatric Ocular Rosacea Patients After a Standard Treatment Protocol","volume":"32","author":"Ceylan","year":"2024","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.3109\/02713683.2015.1088953","article-title":"Morphological and Functional Evaluation of Meibomian Gland Dysfunction in Rosacea Patients","volume":"41","author":"Zakrzewska","year":"2016","journal-title":"Curr. Eye Res."},{"key":"ref_34","first-page":"365","article-title":"Characterization of meibomian gland dysfunction in patients with rosacea","volume":"86","author":"Barbosa","year":"2023","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1136\/bjo.2007.131722","article-title":"Concordance between common dry eye diagnostic tests","volume":"93","author":"Moore","year":"2009","journal-title":"Br. J. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1167\/tvst.8.6.6","article-title":"The Role of Meibography in the Diagnosis of Meibomian Gland Dysfunction in Ocular Surface Diseases","volume":"8","author":"Robin","year":"2019","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1080\/02713683.2017.1406525","article-title":"Changes in the Meibomian Gland After Exposure to Intense Pulsed Light in Meibomian Gland Dysfunction (MGD) Patients","volume":"43","author":"Yin","year":"2018","journal-title":"Curr. Eye Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1007\/s11596-019-2108-1","article-title":"Intense Pulsed Light Therapy for Patients with Meibomian Gland Dysfunction and Ocular Demodex Infestation","volume":"39","author":"Cheng","year":"2019","journal-title":"Curr. Med. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1177\/12034754241254051","article-title":"A Review of Intense Pulsed Light in the Treatment of Ocular Rosacea","volume":"28","author":"Shergill","year":"2024","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_40","first-page":"167","article-title":"Treatment of ocular rosacea: A systematic review","volume":"22","author":"Avraham","year":"2024","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4753","DOI":"10.1167\/iovs.03-0270","article-title":"The relationship between habitual patient-reported symptoms and clinical signs among patients with dry eye of varying severity","volume":"44","author":"Begley","year":"2003","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"409","DOI":"10.3341\/kjo.2023.0062","article-title":"Comparative evaluation of matrix metalloproteinase-9 immunoassay and tear osmolarity measurement for diagnosing severity of dry eye disease","volume":"37","author":"Choi","year":"2023","journal-title":"Korean J. Ophthalmol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s13555-015-0077-2","article-title":"Perceptions on the Psychological Impact of Facial Erythema Associated with Rosacea: Results of International Survey","volume":"5","author":"Micali","year":"2015","journal-title":"Dermatol. Ther. (Heidelb)"},{"key":"ref_44","first-page":"623","article-title":"Current drug therapies for rosacea","volume":"20","author":"Feldman","year":"2014","journal-title":"J. Manag. Care Pharm."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s10103-017-2318-3","article-title":"Treatment of erythemato-telangiectatic rosacea with brimonidine alone or combined with vascular laser based on preliminary instrumental evaluation of the vascular component","volume":"33","author":"Micali","year":"2018","journal-title":"Lasers Med. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1016\/j.jaad.2013.04.045","article-title":"New insights into rosacea pathophysiology: A review of recent findings","volume":"69","author":"Steinhoff","year":"2013","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"AB104","DOI":"10.1016\/j.jaad.2016.02.409","article-title":"Clinicodermoscopic correlations observed in a rosacea group of patients: 2713","volume":"74","author":"Tatu","year":"2016","journal-title":"J. Am. Acad. Dermatol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/3\/105\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:14:19Z","timestamp":1773324859000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/3\/105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["diseases14030105"],"URL":"https:\/\/doi.org\/10.3390\/diseases14030105","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}