Atopic Keratoconjunctivitis
Atopic keratoconjunctivitis is a chronic inflammatory condition that affects both the conjunctiva and the eyelids. It is associated with atopic dermatitis, a condition characterized by dry, itchy, easily irritated skin. Atopic dermatitis generally consists of eczema of the skin just above the forearm, on the back of the legs, hands, face and neck. This skin condition often begins in childhood and improves or resolves as you age. However it is possible to have this condition into adulthood. Approximately 3% of the population has atopic dermatitis, and only a minority of these individuals has associated allergic eye conditions such as atopic keratoconjunctivitis.
If you suffer from atopic keratoconjunctivitis, you may suffer from severe itching, particularly of the eye and the skin over the eye. Unlike allergic conjunctivitis, the skin around your eyes may become dry, scaly, or reddened. The skin in this area may have barely visible microwrinkles, be thickened, or have a slight increase in pigmentation from constant rubbing. Your lid margins may show loss of eyelashes. The underside of your upper lid may have islands of tissue (papillary hypertrophy) which may be irritated by contact lenses or may irritate the cornea. This complication is an important medical problem since it may result in damage to your vision if neglected. Symptoms of atopic keratoconjunctivitis may be seasonal, perennial, or both.
Diagnosis
Diagnosis of atopic keratoconjunctivitis is based on the presentation of typical symptoms and the chronic nature of these symptoms. You may have an association with atopic dermatitis and/or a family history of allergy. A history of symptoms of seasonal flares or worsening with certain allergen exposure is supportive of diagnosis. Not wearing your contact lenses may help differentiate atopic dermatitis from
giant papillary conjunctivitis due to contact lens use.
Treatment
- Environmental controls for environmental allergens at home, school, or in the work environment identified as triggering symptoms
- When environmental allergen controls prove inadequate in the management of symptoms, consider the following medications:
- Topical antihistamines and decongestants
- Mast cell stabilizers or dual acting mast cell stabilizers and antihistamines are helpful when used year round (especially with symptoms of photophobia and tearing)
- If response is inadequate, a 7 - 10 day course of topical corticosteroids should be considered
- Oral antihistamines often help control itching
- For severe flares of symptoms, oral corticosteroids are usually effective. The use of moisturizer and topical corticosteroids or ElidelŪ cream or ProtopicŪ ointment applied to the skin around the eye and eyelid may be helpful in controlling associated atopic dermatitis.
- Oral or topical cyclosporin A may be useful in resistant cases
