A 63‑year‑old woman kept getting painful lumps (chalazions) on her eyelids even though she didn’t have the usual facial redness of rosacea. Tests showed the protein LL‑37 was present in the eye tissue, and her eye problems cleared up after she took oral antibiotics (doxycycline and azithromycin).

In addition to the non-specific symptomatology of ocular rosacea, currently, there are no reliable diagnostic tests for the disease, which may lead to its misdiagnosis. Here, we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids. A 63-year-old female patient presented with multiple chalazion and dry eyes in both eyes, with no facial erythema. Initial management done were application of steroid eye ointment on both eyelids, hot compresses, and eyelid margin cleaning; noting that there was no relief of symptoms. Surgical excision of the chalazion was done on both eyes, however, bilateral recurrence occurred post-operatively. The pathological studies showed infiltration of a small amount of fibrous tissue with many chronic inflammatory cells. Immunohistochemistry studies were positive for LL-37. Resolution of the chalazion occurred after oral administration of doxycycline and azithromycin. Our findings show that ophthalmologists should recognize the ocular manifestations of skin diseases.