✍rare
✍ bilateral
✍ 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.
