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 keratoconjunctivitisClinical 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 keratoconjunctivitisTreatment

✍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.