Atopic Keratoconjunctivitis Definition
Atopic Keratoconjunctivitis is a rare but more severe type of Allergic Conjunctivitis. It is a form of bilateral Conjunctivitis that gives rise to swelling of the Cornea as well the Conjunctiva of a person. Naturally the disease is known as “Keratoconjunctivitis” of which “Kerato” stands for “Cornea”. Simply put, it stands as Conjunctivitis of the Cornea and Conjunctiva due to exposure to allergens.
This condition is also often referred to as “Eczema Eyes”.
Atopic Keratoconjunctivitis Prevalence
Atopic Keratoconjunctivitis (AKC) is associated with 87% asthma prevalence and 95% concomitant eczema. Boys are three times more susceptible to this condition than girls.
Atopic Keratoconjunctivitis Symptoms
Atopic Keratoconjunctivitis symptoms are similar to most other types of Allergic Conjunctivitis. These may be seasonal or perennial or both. Some of the main symptoms of Atopic Keratoconjunctivitis are
Atopic Keratoconjunctivitis makes the eyes extremely red which does not resolve as long as the disease lasts.
Hardening of the eyelids
The inner lining of eyelids get swollen and become hard in this condition. The skin of the eyelid may get thickened and develop crusts, scales and micro-wrinkles that are barely visible.
There is extreme itchiness in the eyes due to exposure of the Conjunctiva to allergens. The itchiness is often accompanied by a stinging or burning sensation in the eyes. The itchiness is prominent in the eyes and the skin over them.
Sensitivity to light
This disease makes both eyes get extremely sensitive to light. The extreme photosensitivity makes it difficult for affected individuals to go out in bright sunlight.
Discharge of tears
As with other types of Allergic Conjunctivitis, there is usually a thick, stringy discharge from both eyes in this disorder.
The teary discharge and extreme photosensitivity leads to blurry vision in sufferers.
In Atopic Keratoconjunctivitis dry eyes are very common. Allergens, on contact with the eye surface, create dry spots on the cornea thus leading to diminished vision and irritation. This is a very discomforting symptom of Atopic Keratoconjunctivitis.
Atopic Keratoconjunctivitis Complications
Unless treated in time, Atopic Keratoconjunctivitis can persist for many years and cause severe complications. It can result in Conjunctival Scarring and Corneal swelling. In severe cases of Atopic Keratoconjunctivitis cataracts and even blindness may occur. It can result in cataract formation in 10% cases. In rare conditions, a sufferer may go completely blind due to this disorder.
Atopic Keratoconjunctivitis Causes
The natural reaction of the mast cell in the eyes against allergens is the main cause of Atopic Keratoconjunctivitis. When the Cornea and Conjunctiva of the eyes are exposed to allergens, the immune system of the body makes a natural response to it. The mast cells release an aminoalkane known as histamine which causes inflammation in the eyes and try to block the allergens.
People working in dusty and polluting environments are highly susceptible to Atopic Keratoconjunctivitis. People who have a tendency of suffering from seasonal allergies can get this disease. Heredity may also be a cause of this disease as it is often seen in people with a family history of allergies.
The condition is also thought to be caused by some common foods such as peanuts, eggs, milk, fish, wheat and soy. These foods are often supposed to be the cause for triggering Atopic Keratoconjunctivitis in people allergic to them.
People with eczema are also found to be at greater risk from this eye disease. Individuals affected with Atopic Keratoconjunctivitis are often seen to suffer from other eye diseases like Atopic Rhinitis, Atopic Dermatitis and Eczema.
Atopic Keratoconjunctivitis Diagnosis
Atopic Keratoconjunctivitis is usually diagnosed on the basis of careful clinical observation of the physical symptoms noted in a person suffering from the disorder. The medical history of the person is also thoroughly examined and taken into account. It is also checked whether the symptoms are chronic in nature. Doctors try to find out if the affected individual has a family history of allergies or has been working in a polluted environment.
Doctors often produce numbness in the eyes by use of anesthesia. Conjunctival scrapings and samples of eye discharge and secretions are collected and analysed to determine the presence of eosinophils. Eosinophiles are a kind of white blood cell (WBC) that releases some major chemical mediators which cause swelling of the airways. Presence of Eosinophils can help diagnose Atopic Keratoconjunctivitis in patients. Atopic disorders like Allergic Rhinitis and Asthma can indicate Atopic Keratoconjunctivitis.
In some cases of Atopic Keratoconjunctivitis contact lenses are needed to be avoided for some time to help doctors distinguish the condition from Giant Papillary Conjunctivitis.
Atopic Keratoconjunctivitis Treatment
A combination of topical and oral decongestants or antihistamines is usually effective in Atopic Keratoconjunctivitis cure. Oral antihistamines can cure more serious cases of the disease can be treated with oral corticosteroids.
Application of Protopic ointment and Elidel creams on the skin around the eyelid and eye can be effective in reducing itchiness and other uncomfortable symptoms produced by the condition. Use of Corticosteroid creams for limited periods over the outer eyelid can provide relief from discomforting symptoms. However, long term use of Corticosteroids is generally not prescribed.
Long term treatment of the disorder may be carried out with the aid of dual action antihistamines and mast cell stabilizers. Using these all year round can help reduce tear discharge and photophobia. Swelling of the Conjunctiva may be treated with the help of Cromolyn Sodium eye drops.
If mast cell stabilizers fail to produce adequate response, a short course of topical corticosteroids may be used as Atopic Keratoconjunctivitis drug for 7-10 days.
Atopic Keratoconjunctivitis medications do not generally involve antibiotics as it is caused by a natural trigger response of the body’s own immune system and not by bacterial or viral infections. But in some cases, Staphylococcus Aureus (golden staph) bacteria cause a secondary infection and result in an infection of the eyelash follicles known as Blepharitis. Antibiotics may be required in such cases.
Immunotherapy, consisting of allergy shots, is not usually recommended for the treatment of Atopic Keratoconjunctivitis.
Atopic Keratoconjunctivitis Management
The chronic nature of Atopic Keratoconjunctivitis often makes its management quite difficult. However, strictly following a combination of steps can help patients in managing this disease. These steps include
As aforesaid, Atopic Keratoconjunctivitis patients become extremely sensitive to light. Wearing sunglasses can help them go out in bright light without suffering from eye pain and discomforts.
Avoiding rubbing the eyes
Rubbing and scratching eyes can further complicate the condition and lead to increased release of histamines from the mast cells. It can also result in permanent scarring of the cornea thereby leading to visual changes. It is thus important to avoid rubbing the eyes.
Atopic Keratoconjunctivitis Pregnancy
Atopic Keratoconjunctivitis in pregnant women can be very discomforting. Even though the disease itself does not cause any complications, medications used in the cure of Atopic Keratoconjunctivitis may lead to serious consequences in pregnancy. It may even result in miscarriage. This makes it important for doctors to prescribe medications that are safe for the mother and the unborn infant.
Atopic Keratoconjunctivitis and Vernal Keratoconjunctivitis
Atopic Keratoconjunctivitis is often confused with Vernal Keratoconjunctivitis due to the similarity of the symptoms produced by them. However, both are different conditions even though they are subtypes of Allergic Conjunctivitis and are caused by exposure of eyes to allergens.
Some key differences of Vernal Keratoconjunctivitis with Atopic Keratoconjunctivitis are:
- Vernal Keratoconjunctivitis, unlike Atopic Keratoconjunctivitis, is mainly seen in hot and dry conditions. Atopic Keratoconjunctivitis, on the other hand, can arise in polluted environments.
- Vernal Keratoconjunctivitis is mostly seen in children and prepubescent boys. In Atopic Keratoconjunctivitis children, teens as well as adults can be sufferers. The peak age of Atopic Keratoconjunctivitis incidence is in people belonging to age group of 30-50 years. However, the disease is most common in older people.
- Conjunctival scarring is less likely in Vernal Keratoconjunctivitis whereas it is more frequent in Atopic Keratoconjunctivitis.
- Vernal Keratoconjunctivitis results in a thick, mucoid release from the eyes whereas Atopic Keratoconjunctivitis leads to a clear, watery discharge.
- Atopic Keratoconjunctivitis commonly leads to deep corneal neurovascularization but that is not the case in Vernal Keratoconjunctivitis.
- It is very likely to find eosinophils in conjunctival scrapings in patients of Vernal Keratoconjunctivitis. Chances of eosinophil presence are less in case of Atopic Keratoconjunctivitis (AKC).
If treated in time, Atopic Keratoconjunctivitis can be cured fast and in an effective manner. If you or anyone in your family is showing AKC symptoms, it is advisable that you start early treatment to get rid of this highly discomforting disease. Proper treatment in time can help avert all future complications and let affected ones get back in the pink of health in little time.
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