Purpose: To report the clinical characteristics, treatment modalities and long term follow-up of 16 pediatric ocular acne rosacea patients. Methods: The medical records of pediatric ocular acne rosacea patients were reviewed. Results: There were 16 patients with a mean age of 7.7 +/- 5 (1-16) years. The mean follow-up period was 52.8 +/- 52 (3-150) months. Eight patients had skin involvement. The mean duration of delay for diagnosis was 16.2 +/- 5.1 (4-48) months. Nine patients had a delayed diagnosis. Meibomitis, blepharitis, lid telangiectasia, and conjunctival hyperemia were present in all cases. Systemic antibiotics were prescribed in 12 patients. The mean delay in diagnosis was longer in patients with conjunctival/corneal involvement (p = .001) and these patients required longer systemic treatment (p = .001). Complete remission was achieved in 87.5% of cases. Conclusion: Children presenting with a long history of ocular irritation, meibomian gland disease, recurrent chalazia and peripheral corneal infiltrates should alert ophthalmologists to consider the diagnosis of ocular acne rosacea even in the absence of skin changes.