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Atopic Keratoconjunctivitis Workup

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

Approach Considerations

No specific laboratory testing is necessary for atopic keratoconjunctivitis (AKC). Although serum immunoglobulin E (IgE) levels are usually elevated during exacerbations, skin testing is not helpful. However, conjunctival biopsy can help to differentiate atopic keratoconjunctivitis from cicatricial pemphigoid.

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Conjunctival Biopsy and Histology

Conjunctival biopsy specimens reveal excessive eosinophils, mast cells, and goblet cells. These specimens can also help to histologically differentiate atopic keratoconjunctivitis from cicatricial pemphigoid by the presence of basement membrane antibodies or complement components in cicatricial pemphigoid.

Confocal microscopy studies of the cornea show lower density of basal epithelial cells, thickening of stromal nerves, and severe inflammatory cells in proximity to nerve fibers.[3]

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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
  1. Foster CS, Calonge M. Atopic keratoconjunctivitis. Ophthalmology. 1990 Aug. 97(8):992-1000. [Medline].

  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].

  4. Casey R, Abelson MB. Atopic keratoconjunctivitis. Int Ophthalmol Clin. 1997 Spring. 37(2):111-7. [Medline].

  5. Akpek EK, Dart JK, Watson S, et al. A randomized trial of topical cyclosporin 0.05% in topical steroid-resistant atopic keratoconjunctivitis. Ophthalmology. 2004 Mar. 111(3):476-82. [Medline].

  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].

  7. Donnenfeld E, Pflugfelder SC. Topical ophthalmic cyclosporine: pharmacology and clinical uses. Surv Ophthalmol. 2009 May-Jun. 54(3):321-38. [Medline].

  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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