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Atopic Keratoconjunctivitis Clinical Presentation

  • Author: Anne Chang-Godinich, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 17, 2015
 

History

When evaluating a patient with suspected atopic keratoconjunctivitis (AKC), look for the following in past medical history:

  • Chronic or chronically relapsing atopic disease, including dermatitis, asthma, and/or rhinitis
  • Ocular symptoms with little or no seasonal variation (as opposed to vernal conjunctivitis that is seen only in warm weather), including itching, tearing, ropy discharge, burning, photophobia, and/or decreased vision
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Physical Examination

On examination, evaluate the following areas of the affected eye(s): the periorbital region, eyelid, conjunctiva, cornea, lens, and fundus.

Periorbital region

Evaluate this area for Dennie-Morgan folds (linear lid folds secondary to chronic eye rubbing) and the Hertoghe sign (absence of lateral eyebrows).

Eyelid(s)

Evaluate the eyelid(s) for thickening and tylosis, crusting, edema, fissures, ptosis, and staphylococcal blepharitis.

Conjunctiva(e)

Evaluate the conjunctiva(e) for small- or medium-sized papillae, hyperemia, edema, excessive mucin, and limbal Trantas dots (clusters of necrotic eosinophils, neutrophils, and epithelial cells) (see the first image below). Keratinization, cicatrization, and symblepharon (adhesion of the palpebral conjunctiva to the bulbar conjunctiva) develop in advanced disease (see the second the image below).

Atopic keratoconjunctivitis. Limbal Trantas dots c Atopic keratoconjunctivitis. Limbal Trantas dots can be seen in this image.
Atopic keratoconjunctivitis. This image depicts a Atopic keratoconjunctivitis. This image depicts a symblepharon.

Cornea(s)

Evaluate the cornea(s) for punctate epitheliopathy and keratitis, persistent epithelial defects, shield-shaped ulcers (as shown in the following image), anterior stromal scarring, and micropannus. Extensive peripheral corneal vascularization occurs in later stages. Note that a higher incidence of keratoconus (16%) and recurrent herpes simplex keratitis is associated with atopic keratoconjunctivitis.

Atopic keratoconjunctivitis. A corneal shield ulce Atopic keratoconjunctivitis. A corneal shield ulcer is illustrated in this image.

Lens(es)

Posterior or anterior subcapsular shield-shaped cataracts are characteristic in atopic keratoconjunctivitis.

Fundus(i)

Evaluate the fundus(i) for degenerative vitreous changes and retinal detachment.

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Contributor Information and Disclosures
Author

Anne Chang-Godinich, MD, FACS Clinical Associate Professor, Department of Ophthalmology, Baylor College of Medicine; Physician, 1960 Eye Surgeons, PA; Attending Surgeon, Veterans Affairs Medical Center of Houston

Anne Chang-Godinich, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Cataract and Refractive Surgery, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Michael B Raizman, MD Associate Professor, Department of Ophthalmology, Tufts School of Medicine; Consulting Staff, Ophthalmic Consultants of Boston, Inc

Michael B Raizman, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Phi Beta Kappa, Pan-American Association of Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.

References
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  2. Power WJ, Tugal-Tutkun I, Foster CS. Long-term follow-up of patients with atopic keratoconjunctivitis. Ophthalmology. 1998 Apr. 105(4):637-42. [Medline].

  3. Hu Y, Matsumoto Y, Adan ES, Dogru M, Fukagawa K, Tsubota K, et al. Corneal in vivo confocal scanning laser microscopy in patients with atopic keratoconjunctivitis. Ophthalmology. 2008 Nov. 115(11):2004-12. [Medline].

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  6. Hingorani M, Moodaley L, Calder VL, Buckley RJ, Lightman S. A randomized, placebo-controlled trial of topical cyclosporin A in steroid-dependent atopic keratoconjunctivitis. Ophthalmology. 1998 Sep. 105(9):1715-20. [Medline].

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  8. Hoang-Xuan T, Prisant O, Hannouche D, Robin H. Systemic cyclosporine A in severe atopic keratoconjunctivitis. Ophthalmology. 1997 Aug. 104(8):1300-5. [Medline].

  9. Anzaar F, Gallagher MJ, Bhat P, Arif M, Farooqui S, Foster CS. Use of systemic T-lymphocyte signal transduction inhibitors in the treatment of atopic keratoconjunctivitis. Cornea. 2008 Sep. 27(8):884-8. [Medline].

  10. Miyazaki D, Tominaga T, Kakimaru-Hasegawa A, Nagata Y, Hasegawa J, Inoue Y. Therapeutic effects of tacrolimus ointment for refractory ocular surface inflammatory diseases. Ophthalmology. 2008 Jun. 115(6):988-992.e5. [Medline].

  11. Labcharoenwongs P, Jirapongsananuruk O, Visitsunthorn N, Kosrirukvongs P, Saengin P, Vichyanond P. A double-masked comparison of 0.1% tacrolimus ointment and 2% cyclosporine eye drops in the treatment of vernal keratoconjunctivitis in children. Asian Pac J Allergy Immunol. 2012 Sep. 30(3):177-84. [Medline].

  12. Al-Amri AM. Long-term follow-up of tacrolimus ointment for treatment of atopic keratoconjunctivitis. Am J Ophthalmol. 2014 Feb. 157(2):280-6. [Medline].

 
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Atopic keratoconjunctivitis. Limbal Trantas dots can be seen in this image.
Atopic keratoconjunctivitis. A corneal shield ulcer is illustrated in this image.
Atopic keratoconjunctivitis. This image depicts a symblepharon.
 
 
 
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