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  • Cornea/External Disease, Pediatric Ophth/Strabismus

    Review of: Definition and diagnostic criteria for pediatric blepharokeratoconjunctivitis

    Morales-Mancillas N, Velazquez-Valenzuela F, Kinoshita S, et al. JAMA Ophthalmology, January 2024

    A panel of international pediatric ophthalmologists and cornea specialists has developed a consensus definition of and diagnostic criteria for pediatric blepharokeratoconjunctivitis (PBKC), a rare chronic inflammatory eyelid margin disease associated with the ocular surface.

    Study Design

    Four rounds of surveys, with the later surveys building on data obtained from the previous rounds, were administered, and 2 virtual face-to-face meetings were conducted at Rounds 1 and 4. The consensus methodology used was the non-RAND modified Delphi method.


    The consensus of the panel was that PBKC is an underdiagnosed, sight-threatening eyelid margin disease with a range of associated symptoms and conditions, including chronic blepharitis, conjunctivitis, meibomitis, and corneal involvement. The panel also distinguished between definitive PBKC and PBKC suspect—a patient with PBKC suspect has eyelid margin and conjunctiva involvement but no cornea involvement. For both confirmed PBKC and PBKC suspect, symptoms include recurrent chalazia, ocular irritation/burning, tearing, chronic discomfort, photophobia, foreign body sensation, blurred vision, and red eye. Skin involvement may or may not be present. To confirm a PBKC diagnosis, the patient must be aged ≤18 years and have ≥1 symptoms in addition to ≥1 signs at each anatomic region (eyelid margin, conjunctiva, and cornea).


    The PBKC definition and diagnostic criteria from this expert panel consensus may have lower reliability because of the lack of published randomized clinical trials, though all panelists have had extensive clinical experience diagnosing children with PBKC. In their conclusion, the authors stated that their next objective is to collect patient data to validate the panel’s diagnostic criteria for PBKC and PBKC suspect.

    Clinical Significance

    For us as pediatric ophthalmologists, a clear-cut definition of and diagnostic criteria for a severe ocular surface inflammatory condition are very important. If we can make an informed diagnosis of PBKC or PBKC suspect, there may be reduced diagnostic confusion, higher rates of earlier detection, and improved treatment for the 3 anatomic sites involved.

    Financial Disclosures: Dr. Jennifer Galvin discloses no financial relationships.