Atopic Keratoconjunctivitis (AKC) Treatment & Management

Updated: May 29, 2019
  • Author: Anne Chang-Godinich, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

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.

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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] Internationally, application of tacrolimus dermatologic ointment in children and adults has shown promise as an effective steroid-sparing alternative. [11, 12, 13]

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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.

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