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Disease
- Peak incidence between 30 and 50 years of age
- Long-standing atopic dermatitis
- Tendency to occur year-round; often worst in winter
Symptoms
- Similar to vernal keratoconjunctivitis but often more severe and without remission
- Conjunctiva is primarily affected palpebral inferior (contrary to vernal keratoconjunctivitis, which predominantly affects the superior conjunctiva)
- Frequent punctate epithelial erosions in the lower third of the cornea
- +/- plaque formation
- +/- peripheral corneal vascularisation and stromal scars
Treatment
- General measures:
- Avoidance of the allergen
- Cold compresses
- Lid hygiene, especially in associated Staphylococcal blepharitis
- Topical medication:
- Mast cell stabilizers, e.g., Cromoglicic acid: Allergo Comod 2% gtt 4x/day
- H1 receptor antagonists, e.g., Emadine SE gtt 4x/day
- Combination preparations, e.g., Zaditen gtt SDU 2x/day or Opatanol gtt 2x/day
- Steroid-containing drops; e.g., Dexafree or FML gtt 3-4x/day, up to every 2 hours in exceptional cases and during acute flare-ups for a few days
- +/- immunomodulators: Cyclosporine 0.05% 2x/day if no response to steroids
- +/- tacrolimus ointment (Protopic) 0.03% 1-2x/day long-term (CAUTION: off-label)
- Consider systemic antihistamines
Differential Diagnoses
Sources
- EyeWiki Atopic Keratoconjunctivitis
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)