One or more manifestations of atopic keratoconjunctivitis (AKC) develop in approximately one-third of patients with atopic dermatitis. Atopic individuals show signs of type I hypersensitivity responses as well as depressed systemic cell-mediated immunity. As a consequence of this altered immunity, they are susceptible to herpes simplex virus keratitis and colonization of the eyelids with Staphylococcus aureus. Complications related to this predisposition to infection may contribute to, or compound, the primary immunopathogenic manifestations. AKC is primarily a type IV reaction; therefore, the use of mast-cell therapy may not be effective.
Treatment of AKC involves allergen avoidance and the use of pharmacotherapeutic agents similar to those used in the treatment of VKC. Cold compresses may also be of benefit. In addition, patients should be carefully monitored for complications of infectious diseases that may warrant specific therapy, such as secondary staphylococcal infections and herpes simplex keratitis, which is more common and more likely to be bilateral in patients with AKC (see Chapter 9).
In severe cases, the indications for systemic therapy include chronic ocular surface inflammation unresponsive to topical treatment, ocular discomfort, progressive cicatrization, and peripheral ulcerative keratopathy. Systemic immunosuppression (eg, cyclosporine or tacrolimus) should be monitored in coordination with an internist or rheumatologist. Systemic treatment of AKC may be beneficial in suppressing the interleukin-2 (IL)-2 response, which promotes lymphocyte proliferation.
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Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.