Atopic Keratoconjunctivitis and Eczema

Reviewed by: HU Medical Review Board | Last reviewed: February 2024

Atopic keratoconjunctivitis (AKC) is a chronic inflammatory disease of the eyes that affects people with atopic dermatitis (eczema). It can cause eyes to become red, itchy, and watery. In severe cases, it can lead to loss of vision.1,2

About 25 to 40 percent of people with eczema also have AKC. In both conditions, the body’s immune system reacts abnormally to an outside object. This irregular reaction is called atopic if the reaction occurs in a part of the body other than where the body made contact with the outside object.1,2

The outside object, which causes the allergic reaction, is called an allergen. In most cases, AKC is caused by an allergen that travels through the air. Possible allergens include:1,2

  • Pollen or mold spores
  • Dust mites
  • Animal dander (tiny flakes of skin)

Symptoms of AKC

AKC causes swelling of the conjunctiva, which is a thin membrane covering the inside of the eyelids and the white parts of the eyes. AKC also can cause the whites of the eyes to become red. The eyes may become itchy and release a liquid that can be watery or stringy.1-3

AKC can lead to blurry vision and a sensitivity to light. The condition affects both eyes, and symptoms can be present throughout the year or may become worse during certain seasons.1-3

How is AKC diagnosed?

Usually, a doctor will need to do an eye exam to diagnose AKC. The doctor may also ask about any family history of allergies or eczema, since this can increase the risk of developing AKC.1-4

During the eye exam, the doctor will look for different signs of AKC. These may include:1-4

  • Thick or crusted skin on the eyelids or around the eyes
  • Swollen conjunctiva – The thin, transparent layer that covers the eyeballs and the back of the eyelids can become swollen and develop bumps or scars.
  • Corneal damage – The cornea is the part of the eye that passes through the light you see. AKC can damage the cornea, which can lead to permanent loss of vision.
  • Cataracts – The lens of the eyes can become cloudy, resulting in cataracts. AKC increases a person’s likelihood of getting cataracts.

In addition to an eye exam, lab tests may also be used to diagnose AKC. Tears or cells taken from the eyelids can be tested. These tests check whether certain proteins or immune cells that are present during an allergic reaction are present in the eyelids.1,2

How is AKC treated?

AKC can be treated in multiple ways.

Symptom management

In mild cases, symptoms may get better with cold compresses and tear supplements. If the allergen is known, then avoiding the allergen (if possible) is highly recommended.1-4

Antihistamines/mast cell stabilizers

Antihistamine drugs reduce the inflammation caused by an allergic reaction. For AKC, antihistamines usually come in the form of eye drops. Similarly, mast cell stabilizers are a class of drugs that try to stop the immune system from reacting to allergens.1,2

These types of drugs can be used together for best results. In some cases, oral antihistamines might also be given.1,2

Topical steroids and immunosuppressants

AKC can be treated with steroids if other drugs do not work. Steroids reduce the inflammation caused by the allergen.1,2

Another class of drugs called immunosuppressants (like cyclosporine) may also be used. These drugs calm down the immune system response. Steroids and immunosuppressants have side effects. Steroids and immunosuppressants can be used directly on the eyelids or taken by mouth for a systemic (whole-body) effect. They generally should only be used after trying other treatments first.1,2

Other things to know

AKC can look like other allergy-related diseases. So, diagnosis and treatment of AKC may require a team of healthcare professionals. This can include doctors who are experts in treating eye problems, skin conditions, or allergies.2

AKC and some of the drugs used to treat it can cause damage to other parts of the eyes. In severe cases, this could lead to loss of vision. People with AKC usually need to see their eye doctor regularly to deal with any potential complications. If AKC causes damage to other parts of the eye, then surgical options are available to treat the damage.2

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