What is Atopic Keratoconjunctivitis?

Last updated: February 2022

Atopic Keratoconjunctivitis (AKC) is an eye condition that occurs in approximately 20-40% of people who have atopic dermatitis, though it is not limited to atopic dermatitis patients.1 AKC is similar in nature to other atopic eye conditions, including recurrent allergic keratoconjunctivitis, vernal keratoconjunctivitis and giant papillary conjunctivitis.1,2 AKC has the potential to lead to blindness.

What are symptoms of AKC?

AKC is always associated with another atopic diagnosis, such as atopic dermatitis or asthma.2 Patients with AKC often have severe eczema of the eyelids. Patients have itching, tearing or watering of the eyes, pain and discomfort, stringy discharge, light sensitivity, and blurry vision.1,2 Patients will also often present with swelling of the insides of the eyelids and of the whites of the eyes, corneal erosions, and cataracts.2 These symptoms may be present year-round, but sometimes cycle through the changes of the seasons.2

How is AKC diagnosed?

There are no definitive tests to determine if a patient has AKC, but most patients will test positive for elevated Immunoglobulin E (IgE) levels.1 An ophthalmologist may also take a biopsy of the conjunctiva (the lining of the eyelid and sclera, or white part of the eye) to look for the presence of cells that indicate a patient is having AKC rather than an autoimmune eye condition.1 These tests are usually only indicated if there is uncertainty about a diagnosis. Otherwise, physicians will use patient and family histories of atopic diagnoses, and the presence of clinical symptoms to diagnose AKC.2

How is it treated?

AKC can be treated in multiple ways. Physicians may begin with the most conservative, non-medication approach of cold compresses, preservative-free lubricant eye drops, and topical treatments, such as topical cromones, or antihistamines.2 For medications, physicians may start with over-the-counter antihistamine drops such as ketotifen fumurate (0.025%). This is the active ingredient in Zatidor™ and Alaway™. Other prescription topical antihistamines that could be prescribed include olaptadine hydrochloride (Patanol ™/Pataday™) or epinastine hydrochloride (Elestat™).1 Physicians also might recommend oral antihistamines such as loratadine, cetirizine or fexofenadine.2

Severe AKC treatments

When these strategies fail, practitioners may move to corticosteroids to help reduce inflammation. These corticosteroids may be topical, such as loteprednol etabonate (Lotemax™, Alrex™), prednisolone acetate (PredForte™) or fluorometholone (FML™)1, or oral medications such as prednisone, and methylprednisolone. If patients continue to have severe symptoms, physicians can use topical, oral and injectable (systemic) immune-suppressive medications. Topically, this would include cyclosporine (Restatis™) drops.1 Orally, cyclosporine, mycophenolate mofetil and azathioprine are all immunosuppressant medications that are used in conjunction with corticosteroids to treat AKC.2 Systemic cyclosporine and tacrolimus have been used to treat AKC with good response.1 There have been some clinical trials using monoclonal antibodies such as infliximab and rituximab, but there is not a lot of data to show if AKC responds to these agents.2

Surgical options

Finally, there are elective surgeries that are available for patients who have damage caused by AKC. These include cataract surgery and corneal transplants, but these are only recommended for patients who have their AKC inflammation under control. Uncontrolled inflammation could lead to corneal transplant failure.1

Talk to your physician about any concerns you have concerning AKC. While it is a potentially disabling condition, there are treatments available for both mild and severe cases. Be aware of your symptoms and know that AKC may mimic a lot of other atopic and allergic ocular issues. If you have concerns, ask your physician for a referral to an ophthalmologist or allergist for a second opinion.

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