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Atopic Keratoconjunctivitis

What is atopic keratoconjunctivitis (AKC)?

AKC is the result of atopy, a genetic condition in which the immune system produces higher than normal antibodies in response to a given allergen. Although AKC is a year-round disease, symptoms may worsen in the winter. Unlike atopic dermatitis, which is generally seen early in childhood, atopic keratoconjunctivitis appears during late adolescence and early adulthood. Men are more commonly affected than women.

How do I know if I have atopic keratoconjunctivitis?

With AKC, the conjunctiva lining the eyelids is usually red and swollen, with the lower eyelid generally more affected than the upper. AKC can progress to ulceration, scarring, cataract, keratoconus, and corneal vascularization.  The most common symptoms of atopic keratoconjunctivitis include:

  • light sensitivity,
  • itching, burning, tearing, and
  •  red and thickened eyelids.

Risk factors of keratoconjunctivitis include a family history of multiple allergies, exzema or asthma, and a previous diagnosis of atopic dermatitis.

How is atopic keratoconjunctivitis treated?

AKC is usually treated with a combination of oral and topical antihistamines along with topical mast cell stabilizers. These are normally effective in controlling most symptoms. In more severe cases, there is the potential for damage to the eye caused by scratching and rubbing. An ophthalmologist may advise you to:

  • Wear cotton gloves at night to prevent unintentional damage to the ocular surface.
  • Apply cold compresses and saline irrigation to lower the elevated tear pH.
  • In more severe cases, consider topical steroid therapy. Other steroid-sparing agents may be helpful, including cyclosporine or tacrolimus.

Be aware that systemic treatment of the conditions that accompany AKC may be very helpful.

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