Atopic keratoconjunctivitis (AKC)

Atopic  keratoconjunctivitis (AKC) can be thought of as an adult equivalent of vernal keratoconjunctivitis and is often associated with atopic dermatitis. Most of the patients are young atopic adults, with male predominance.

Symptoms include:

• Itching, soreness, dry sensation.
• Mucoid discharge.
• Photophobia or blurred vision.

Signs

• Lid margins are chronically inflamed with rounded posterior borders.
• Tarsal conjunctiva has a milky appearance. There are very fine papillae, hyperaemia and scarring with shrinkage.
• Cornea may show punctate epithelial keratitis, often more severe in lower half. There may also occur corneal vascularization, thinning and plaques.

Clinical course. Like the dermatitis with which it is associated, AKC has a protracted course with exacerbations and remissions. Like vernal keratoconjunctivitis it tends to become inactive when the patient reaches the fifth decade.

Associations may be keratoconus and atopic cataract.

Treatment is often frustrating.

• Treat facial eczema and lid margin disease.
• Sodium cromoglycate drops, steroids and tear supplements may be helpful for conjunctival lesions.