ocular surface manifestations of different degrees of severity (e.g., phlyctenular keratitis, superficial punctu- ate keratopathy, conjunctival hyperemia) that corre- spond to meibomitis, and a response to treatment with systemic antibiotics and lid hygiene. Because meibomi- tis is always involved in these clinical entities, “mei- bomitis-related keratoconjunctivitis” may be a suitable term for them. Conversely, “meibomian keratoconjunctivitis,” which indicates superficial punctuate keratopathy related to mei- bomian gland dysfunction in postmenopausal women is a clinically different disease. 4 Theoretically, the elimination of bacteria such as Propionibacterium acnes in the meibomian gland appears to be essential for curing ocular surface inflammation in childhood “meibomitis-related keratoconjunctivitis.” Therefore, we sug- gest that the rationale for antibiotic treatment and lid hygiene in pediatric or adolescent patients with meibomitis- related keratoconjunctivitis is basically the same as for gastri- tis associated with Helicobacter pylori. TOMO SUZUKI SHIGERU KINOSHITA Kyoto, Japan REFERENCES 1. Doan S, Gabison EE, Nghiem-Buffet S, et al. Long-term visual outcome of childhood blepharoconjunctivitis. Am J Ophthal- mol 2007;143:528 –529. 2. Suzuki T, Mitsuishi Y, Sano Y, et al. Phlyctenular keratitis associated with meibomitis in young patients. Am J Ophthal- mol 2005;140:77– 82. 3. Cetinkaya A, Akova YA. Pediatric ocular rosacea: long-term treatment with systemic antibiotics. Am J Ophthalmol 2006; 142:816 – 821. 4. McCully JP, Sciallis CF. Meibomian keratoconjunctivitis. Am J Ophthalmol 1977;84:788 –793. REPLY SUZUKI AND ASSOCIATES SUGGEST THAT BLEPHARO- keratoconjunctivitis may not be an adequate term for naming this disease occurring in young patients and characterized by meibomitis, phlyctenular conjunctivitis, and keratitis. We fully agree with them. None of the current denominations fully describe this disease: blepharokeratoconjunctivitis is vague and nonspecific; phlyctenular keratoconjunctivitis is more precise but does not include meibomitis and may be present in other diseases such as chlamydial keratoconjunctivitis; childhood ocular rosacea reflects the resemblance with adult rosacea, but only a few patients have cutaneous rosacea, 1 and the relationship between the two diseases remains unclear. In our opinion, “meibomitis-related phlyctenular keratoconjunc- tivitis” may be a more appropriate term. Lid hygiene and long-term systemic antibiotic therapy with erythromycin or cyclines represent the first-line treatments. 2 However, corneal inflammation may still not be completely controlled in severe cases. Contrary to Helicobacter pylori-related gastritis, meibomitis-re- lated phlyctenular keratoconjunctivitis is an infectious and inflammatory disease. Topical steroids may then be needed, and inflammation often recurs after their dis- continuation. Topical 2% cyclosporine is in our opinion the most potent treatment for these steroid-dependent forms, because the disease will usually not recur after six to 12 months of treatment, which is not the case even after long-term topical steroid therapy. 3 SERGE DOAN Paris, France REFERENCES 1. Nazir SA, Murphy S, Siatkowski RM, Chodosh J, Siatkowski RL. Ocular rosacea in childhood. Am J Ophthalmol 2004;137: 138 –144. 2. Meisler DM, Raizman MB, Traboulsi EI. Oral erythromycin treatment for childhood blepharokeratitis. J AAPOS 2000;4: 379 –380. 3. Doan S, Gabison E, Gatinel D, Duong MH, Abitbol O, Hoang-Xuan T. Topical cyclosporine a in severe steroid- dependent childhood phlyctenular keratoconjunctivitis. Am J Ophthalmol 2006;141:62– 66. Prevention of Exposure of Porous Orbital Implants Following Enucleation EDITOR: WE READ WITH INTEREST THE RECENT ARTICLE “PREVEN- tion of Exposure of Porous Orbital Implants Following Enucleation” by Dr Wang and associates. 1 The authors have described their technique of anterior scleral patch over a Vicryl mesh-wrapped hydroxyapatite implant and have concluded that this technique would prevent implant exposure. We congratulate Dr Wang and associates for emphasiz- ing the utility of an anterior wrap and their extensive discussion of the literature concerning prevention of im- plant exposure. We agree with the authors that an anterior patch graft can contribute towards preventing exposure of porous orbital implants. While the authors have used Vicryl mesh with hydroxy- apatite implants, we have practiced the scleral cap tech- nique with porous polyethylene implants using a 12-mm anterior scleral patch graft. 2,3 Although it is thought that anterior patch grafts can decrease the vascularization of the implant’s anterior surface, we believe that it forms an CORRESPONDENCE VOL. 144,NO. 1 161