Atopic Keratoconjunctivitis

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

Background

Atopic keratoconjunctivitis (AKC) is a relatively uncommon but potentially blinding ocular condition. In 1952, Hogan described this disease as a bilateral conjunctivitis occurring in 5 male patients with atopic dermatitis. Originally reported to flare with worsening dermatitis, atopic keratoconjunctivitis in some patients evolves independent of dermatitis. [1]

Atopy affects 5-20% of the general population. Atopic keratoconjunctivitis not only occurs in 20-40% of individuals with atopic dermatitis, it is associated with a 95% prevalence of concomitant eczema and an 87% prevalence of asthma. This condition is more prevalent in men than in women, and the peak age of incidence is in persons aged 30-50 years (range, late teens to 50 y)

Other than atopic keratoconjunctivitis, common ocular atopic phenomena include allergic conjunctivitis, giant papillary conjunctivitis, and vernal keratoconjunctivitis.

For patient education information, see Eye and Vision Center and Skin, Hair, and Nails Center, as well as Pinkeye, Eye Allergies, and Eczema.

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Pathophysiology

Atopy refers to hypersensitivity in patients with familial histories of allergic disease. Individuals with atopy often have environmental allergies, allergic asthma, rhinitis, and atopic dermatitis or eczema. Less commonly, these individuals exhibit food allergies, urticaria, and nonhereditary angioedema. Immunoglobulin E (IgE) is the serum mediator of the exuberant responses.

Hypersensitivity reactions associated with types I and IV contribute to the inflammatory changes of the conjunctiva and the cornea that are found in atopic keratoconjunctivitis (AKC). During exacerbations, patients have increased tear and serum IgE levels and increased numbers of circulating B cells, whereas T-cell levels are depressed.

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Prognosis

Atopic keratoconjunctivitis (AKC) may result in decreased vision or blindness from corneal complications, such as chronic superficial punctate keratitis, persistent epithelial defects, corneal scarring or thinning, keratoconus, cataracts, and symblepharon formation. [2]

Complications result from persistent surface keratopathy, corneal scarring or thinning, keratoconus, cataracts, and symblepharon formation. In addition, medical treatment with corticosteroids can further promote the development of cataracts, glaucoma, and secondary corneal infections.

Proper prophylactic measures, prompt effective treatment of exacerbations, and well-timed elective surgical intervention can reduce the incidence of poor vision and blindness.

Patients should be observed every few days or weeks until the ocular surface disease is stable. Moreover, when medically treating patients with steroids or immunosuppressants, a regular interval survey for drug-related adverse effects and complications is indicated.

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