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Atopic Keratoconjunctivitis


Presentation

  • A 45-year-old man presented with the complaints of frequent change in glass prescriptions over the past 5 years. Erythema, dryness, and scaling were noted over both eyelids and the face.[ncbi.nlm.nih.gov]
  • At the eye exam: his best-corrected visual acuity at the initial presentation was 0.2 in the right eye and 1.0 in the left eye.[ncbi.nlm.nih.gov]
  • The findings of the present study reveal that sodium cromoglycate has no significant role in the management of atopic keratoconjunctivitis.[ncbi.nlm.nih.gov]
  • A ten-year-old patient with atopic keratoconjunctivitis, keratoconus and alopecia areata is presented. This patient has also been receiving treatment for Hashimoto thyroiditis (chronic lymphocytic thyroiditis) for more than three years.[ncbi.nlm.nih.gov]
  • Finally, current treatment options for AKC is reviewed and presented as a stepwise, multidisciplinary approach that involves the allergist/immunologist's medical interventions of topical and systemic immunomodulating agents, as well as the surgical skills[ncbi.nlm.nih.gov]
Asymptomatic
  • Eight months after treatment, there were no signs of reactivation, and the patient remains asymptomatic.[ncbi.nlm.nih.gov]
  • At the end of two months patient was asymptomatic with a significant improvement in his quality of life.[ncbi.nlm.nih.gov]
  • Eight patients remained asymptomatic for up to 3 years, although recurrence occurred in 3 patients who attempted to discontinue treatment. All patients complained of a mild burning sensation upon application of the ointment.[ncbi.nlm.nih.gov]
  • Group A streptococci often colonize the pharynx of asymptomatic people, especially school-age children.[psoriasiseczema.com.au]
Noncompliance
  • One patient was noncompliant and continued the treatment only for 7 months. During the median treatment period of 21.5 months for the 7 continuing patients, a total of only 2 flare-up episodes were noted requiring topical steroids.[ncbi.nlm.nih.gov]
Suggestibility
  • In vitro studies have suggested that breakdown of corneal epithelial barrier function and subsequent activation of stromal fibroblasts may amplify ocular allergic inflammation.[ncbi.nlm.nih.gov]
  • This observation suggests that omalizumab may be a good option for the treatment of severe AKC, especially to avoid side effects of immunosuppressive treatments, as suggested for other allergic diseases.[ncbi.nlm.nih.gov]
  • RESULTS: The mean fluorescein scores, conjunctival injection, oedema scores and papillary formation were significantly higher in AKC patients compared to controls (p CONCLUSION: This study suggests the presence of an eosinophilic response in AKC disease[ncbi.nlm.nih.gov]
  • This report suggests that systemic CSA represents an interesting alternative therapy in severe AKC.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: While the AKC findings were not surprising, the result in OCP and SJS suggests that MC(S) play an underappreciated role in the inflammatory process of these disorders.[ncbi.nlm.nih.gov]

Workup

  • […] tear breakup time (TBUT) The Schirmer test Tear meniscus height Quantification of tear components through analysis of tear proteins Impression cytology to monitor progression of ocular surface changes Additional tests that may be used in a research workup[emedicine.medscape.com]

Treatment

  • Cyclosporin A is effective in the treatment of atopic dermatitis and keratoconjunctivitis.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Tacrolimus dermatologic ointment is a potentially safe and effective treatment for AKC cases refractory to standard treatment and may substitute for steroid treatments aimed at controlling disease activity. Copyright 2014 Elsevier Inc.[ncbi.nlm.nih.gov]
  • PARTICIPANTS: Twenty-two patients with AKC refractory to topical steroid treatment.[ncbi.nlm.nih.gov]
  • Application of tacrolimus 0.03% dermatologic ointment into the lower fornix seems to constitute an interesting alternative treatment for atopic keratoconjunctivitis that is refractory to traditional treatment.[ncbi.nlm.nih.gov]
  • Topical immunomodulators such as tacrolimus have revolutionized the treatment of atopic dermatitis.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: Adequate topical immunomodulation using topical calcineurin inhibitors may eliminate the need for steroids and favorably alter the long-term prognosis of patients with AKC.[ncbi.nlm.nih.gov]
  • Prognosis The prognosis and outcomes in AKC depend on whether the condition was treated and managed promptly or whether it progresses.[myvmc.com]
  • Conclusion Clinicians should be aware of Kocuria keratitis as a corneal complication of AKC, and that rapid diagnosis of Kocuria keratitis may improve visual prognosis.[aacijournal.biomedcentral.com]
  • . – Visual prognosis: Visual prognosis is worse for AKC. – Peri-orbital skin and eyelid: There is increased peri-orbital and eyelid skin involvement in AKC as compared to VKC which generally spare skin. – Papillae: AKC usually presents with micro-papillae[aimu.us]
  • […] or drinking alcohol Regular medical screenings at periodic intervals with physical examinations are mandatory, for those diagnosed with the disorder Taking prophylactic medications are essential to prevent worsening of the eye condition What is the Prognosis[dovemed.com]

Etiology

  • (Etiology) Atopic Keratoconjunctivitis is caused by exposure to external agents or particles that cause an allergic inflammatory response.[dovemed.com]
  • Differentiating Features in Acute Conjunctivitis Etiology Discharge/Cell Type Eyelid Edema Node Involvement Itching Bacterial Purulent/polymorphonuclear leukocytes Moderate Usually none None Viral Clear/mononuclear cells Minimal Often present None Allergic[merckmanuals.com]
  • Etiology The International Dry Eye WorkShop (DEWS) developed a 3-part classification of dry eye based on etiology, mechanisms, and disease stage. [1] This classification system distinguishes 2 main categories (or causes) of dry eye states, as follows:[emedicine.medscape.com]
  • Patients with asthma, hay fever or animal allergies may be at greater risk for GPC; its etiology may be immunological, where contact lens deposits act as allergens.[oraclinical.com]
  • , if skin lesions or another pre-existing dermatitis is aggravated after varicella (smallpox) infection then EH must be considered and antiviral therapy must be started immediately. 11 AD, is an immunoglobulin E (IgE)-mediated disease with a complex etiology[psoriasiseczema.com.au]

Epidemiology

  • […] study designs should include adequate randomisation and concealment of allocation; masking of participants, personnel and outcome assessors; adequate follow-up periods and minimisation of attrition bias; and comparison groups with similar clinical and epidemiologic[ncbi.nlm.nih.gov]
  • Diagnosis: Atopic Keratoconjunctivitis Epidemiology Males Females Predominately presents between the late teenage years and the fifth decade of life[1] Spontaneous resolution in elderly Associated with atopic dermatitis in 95% of cases[2] Associated with[webeye.ophth.uiowa.edu]
  • Epidemiologic studies have consistently demonstrated strong associations between rhinitis and asthma.[psoriasiseczema.com.au]
  • The epidemiology of ocular and nasal allergy in the United States, 1988-1994. Journal of Allergy and Clinical Immunology. 2010;126(4):778-783. Bielory B and Bielory L. Atopic dermatitis and keratoconjunctivitis.[eyewiki.aao.org]
  • The epidemiology of allergic eye diseases is reported in eye clinic based studies observing the proportion of all patients seen who have an allergic eye disease.[worldallergy.org]
Sex distribution
Age distribution

Pathophysiology

  • The possible pathophysiological significance of these findings is discussed.[ncbi.nlm.nih.gov]
  • We hypothesized that S. aureus-secreted enterotoxins (SE) are involved in the pathophysiology of atopic keratoconjunctivitis (AKC).[ncbi.nlm.nih.gov]
  • CONCLUSION: These results indicate that the TH2-like cytokines play an important pathophysiological role in severe ocular allergic conditions such as AKC and VKC and that tear level of IL-5 may be a candidate marker to evaluate the clinical status of[ncbi.nlm.nih.gov]
  • The pathophysiology of AKC has not been fully elucidated, and the triggers are still unknown. Corticosteroids are very effective in controlling the acute symptoms of AKC.[clinicaltrials.gov]
  • Despite much current research interest, the pathophysiology of these disorders and their optimum treatment remain uncertain.[books.google.com]

Prevention

  • Proper diagnosis of AKC especially when associated with dermatological signs along with management of AD in conjunction with dermatologist is necessary to prevent corneal involvement which can cause permanent visual disability is of utmost importance.[ncbi.nlm.nih.gov]
  • Prevent aggravation of the condition by staying out of the sun, keeping away from dust and smoke.[dovemed.com]
  • Pediatric AKC requires appropriate and aggressive treatment to prevent sight-threatening corneal complications. Systemic immunosuppressant should be considered when traditional topical anti-inflammatory therapies have failed.[ncbi.nlm.nih.gov]
  • More information Atopic Keratoconjunctivitis (AKC) Prevention The general principle for preventing all allergies is to avoid the triggers .[myvmc.com]
  • In order to prevent corneal perforations, amniotic membrane transplantation (AMT) was used to promote epithelialization.[ncbi.nlm.nih.gov]

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