Recurrent Red Eye Misdiagnosed as Conjunctivitis: Ocular Rosacea With Corneal Neovascularization in a Young Patient

Chronic red eye is a prevalent presentation in both primary care and emergency settings. While most cases are self-limiting, recurrent or treatment-resistant episodes warrant systematic evaluation to exclude underlying chronic inflammatory conditions. We report the case of a 19-year-old female patient with a longstanding history of bilateral red eye associated with pain, photophobia, and epiphora, initially and repeatedly managed as infectious conjunctivitis in the emergency department (ED). Despite multiple antibiotic courses, symptoms persisted. Ophthalmologic evaluation ultimately revealed chronic anterior and posterior blepharitis with meibomian gland dysfunction, peripheral corneal infiltrates, and neovascularization (NV) - findings consistent with ocular rosacea. Notably, subtle cutaneous signs of rosacea were also identified on clinical examination, further supporting the diagnosis. Following targeted therapy with oral doxycycline 100 mg twice daily, topical corticosteroids (CSs), and ocular lubricants, the patient achieved significant clinical improvement. This case highlights the diagnostic pitfalls of recurrent red eye in primary care, the importance of recognizing chronic inflammatory ocular surface disease, and the value of timely ophthalmologic referral in preventing irreversible corneal complications.