Prevalence of ocular manifestations in cutaneous rosacea: Protocol for a systematic review and meta-analysis

Introduction: Rosacea is a chronic inflammatory skin condition with concomitant ocular manifestations and neurogenic symptoms. Ocular rosacea poses a particular diagnostic challenge as its signs and symptoms often overlap with other ocular pathologies. Cutaneous and ocular rosacea present together in approximately 21-50% of patients, yet a solid understanding of comorbid ocular and cutaneous symptoms is lacking. Therefore, the present paper outlines a protocol for a systematic review and meta-analysis to describe and quantify the prevalence of ocular rosacea in cutaneous rosacea and each of its subtypes. Methods: This study will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and be conducted using the systematic review software, Covidence. To determine inclusion, screening will occur at two levels (title and abstract-only followed by full-text) and will be completed separately by two authors. Primary research studies on ocular rosacea in adult cutaneous rosacea published in all languages and geographic regions until November 2023 will be reviewed for inclusion. Data pertaining to overall prevalence of ocular rosacea across and within cutaneous rosacea subtypes, mean age, sex, gender, ethnicity, socioeconomic status, time to diagnosis, time to treatment, and prevalence of comorbid conditions will be extracted. For each included study, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework will be applied to assess study quality. Conclusion: To the authors knowledge, this will be the first systematic review and meta-analysis comparing the prevalence of ocular rosacea in the various cutaneous subtypes in an adult population. By addressing this knowledge gap, this study aims to provide clear and easily interpretable data to aid in the early diagnosis and treatment of ocular rosacea. This study is registered in the International Prospective Register of Systematic Reviews (PROSPERO ID# CRD42023475026). Key MessageProtocol for a systematic review and meta-analysis investigating the prevalence of ocular manifestations in adult rosacea