Atopic Keratoconjunctivitis Treatment & Management
- Author: Anne Chang-Godinich, MD; Chief Editor: Hampton Roy Sr, MD more...
Approach Considerations
Proper prophylactic measures, prompt effective treatment of exacerbations, and well-timed elective surgical intervention can reduce the incidence of poor vision and blindness.
Mast cell stabilizers and antihistamines are the mainstays of prophylactic therapy. Antihistamines, steroids, and other immunosuppressives are used for immediate control of symptoms. Comanagement with an allergist is indicated for optimal long-term control.
Plasmapheresis has been suggested as a successful adjunct therapy for patients with high immunoglobulin E (IgE) levels.
Prophylaxis and Management of Exacerbations
Efforts to reduce or eliminate environmental allergen exposure must be addressed for optimal long-term control of atopic keratoconjunctivitis (AKC). These efforts in combination with topical and oral antihistamines are invaluable in controlling this condition.[1, 4]
Topical mast cell stabilizers reduce the incidence of exacerbations. Intensive topical steroids are used for short-term flare-ups, tapering according to clinical response.[1, 4]
In some situations, more aggressive or steroid-sparing treatment may be indicated. Topical 0.05% or 2% cyclosporine suspended in oil used 4-6 times per day is proven to be effective for exacerbations and may be considered as an adjunct or as possible alternate therapy in situations in which steroid use needs to be minimized.[5, 6, 7]
Systemic cyclosporine (5 mg/kg/d) has been shown to be effective in inducing remission. Low-dose maintenance therapy (5 mg/kg q5d) may be required in refractory cases.[8]
It is important to keep in mind that when medically treating patients with steroids or cyclosporine, patients must be monitored regularly for drug-related adverse effects and complications.
T lymphocyte immunomodulators, such as tacrolimus, have been used in refractory cases with good response. These agents are administered systemically[9] or topically in ointment form.[10]
Elective Surgical Intervention
Atopic keratoconjunctivitis (AKC) is primarily managed medically. However, in some cases in which inflammation is well controlled, elective surgery may be of benefit. Cataract surgery with intraocular lens implantation has been associated with favorable outcomes.[2] However, penetrating keratoplasty for corneal scarring is associated with a higher than average incidence of graft failure. Ocular surface inflammation should be well controlled before surgery.
Foster CS, Calonge M. Atopic keratoconjunctivitis. Ophthalmology. Aug 1990;97(8):992-1000. [Medline].
Power WJ, Tugal-Tutkun I, Foster CS. Long-term follow-up of patients with atopic keratoconjunctivitis. Ophthalmology. Apr 1998;105(4):637-42. [Medline].
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. Nov 2008;115(11):2004-12. [Medline].
Casey R, Abelson MB. Atopic keratoconjunctivitis. Int Ophthalmol Clin. Spring 1997;37(2):111-7. [Medline].
Akpek EK, Dart JK, Watson S, et al. A randomized trial of topical cyclosporin 0.05% in topical steroid-resistant atopic keratoconjunctivitis. Ophthalmology. Mar 2004;111(3):476-82. [Medline].
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. Sep 1998;105(9):1715-20. [Medline].
Donnenfeld E, Pflugfelder SC. Topical ophthalmic cyclosporine: pharmacology and clinical uses. Surv Ophthalmol. May-Jun 2009;54(3):321-38. [Medline].
Hoang-Xuan T, Prisant O, Hannouche D, Robin H. Systemic cyclosporine A in severe atopic keratoconjunctivitis. Ophthalmology. Aug 1997;104(8):1300-5. [Medline].
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. Sep 2008;27(8):884-8. [Medline].
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. Jun 2008;115(6):988-992.e5. [Medline].

