Atopic keratoconjunctivitis diagnosis and treatment

✍ serious

✍ adult onset(onset 25–35 yrs )

✍ History of atopy

☝ eczema of the lids

☝staphylococcal lid disease.

☝ asthma

✍ mixed types I and IV hypersensitivity response, but with a higher T-helper 1 cell type component than in vernal disease.

✅ Atopic keratoconjunctivitis  Clinical picture

✍ symptoms

☝ Itching

☝redness

☝photophobia

☝ blurred vision (if keratitis)

✍ History of atopy

☝ lid eczema (often severe)

☝chronic staphylococcal lid disease (anterior blepharitis)

☝asthma

✍ Signs

☝ small tightly packed papillae

☝featureless tarsal conjunctiva (due to inflammation)

☝chemosis

☝limbal hyperaemia (acute exacerbations)

☝slowly progressive conjunctival scarring (chronic) with forniceal shortening.

☝ Keratitis

• inferior punctate epithelial erosions

• shield ulcers

• pannus

• corneal vascularization

• herpes simplex

• microbial keratitis.

✍ Ocular Associations

☝keratoconus

☝cataract (anterior subcapsular type).

✍ Systemic associations

☝ skin eczema

☝ asthma

✅ Atopic keratoconjunctivitis Treatment

✍ Topical

☝preservative-free ocular lubricants

☝mast cell stabilizer (usually less effective than in VKC)

☝topical steroid (dexamethasone 0.1% PF hourly)

☝ ciclosporin (2% g or 0.2% oc 3–4 x /d).

✍ Systemic

☝oral antihistamines (may help with itching)

☝corticosteroids

☝ immunosuppressants

• calcineurin inhibitors ( tacrolimus ) are particularly effective

☝ when using immunosuppressants, consider antiviral (aciclovir 200mg 5×/d or 400mg 2×/d), as patients are vulnerable to herpetic (HSV) disease.

✍ Surgical

☝ debridement or superficial lamellar keratectomy to remove plaques ( chronic keratitis)

✍ For lid disease

☝ topical antibiotics ( chloramphenicol 1% oc 4×/d)

☝ oral doxycycline 50–100mg once daily for 3 months

• note contraindications in kidney and liver diseases, children < 13 yrs , pregnant and lactating women

✍ For 2ry infective keratitis

☝ topical antivirals

☝ topical antibiotics.

✍ for Skin disease

☝ liaise with dermatologist

☝ topical tacrolimus to facial skin, periocular regions to the lid margins.