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Diagnosis and management of chronic blepharokeratoconjunctivitis in children
1Department of Ophthalmology, Save Sight Institute, Sydney Eye Hospital, Australia.
Insights
Childhood blepharokeratoconjunctivitis is a chronic inflammatory condition with varied presentations. Effective treatment involves oral erythromycin and topical steroids, though relapses are common.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Microbiology
Background:
- Blepharokeratoconjunctivitis (BKC) is an inflammatory eye condition affecting children.
- Understanding its clinical presentation and treatment is crucial for pediatric eye care.
Purpose of the Study:
- To detail the history, symptoms, clinical signs, and treatment of childhood blepharokeratoconjunctivitis.
- To analyze the effectiveness of oral erythromycin and topical steroids in managing BKC.
Main Methods:
- A cohort of eight children diagnosed with BKC was studied.
- Treatment included lid hygiene, oral erythromycin, and preservative-free topical steroids.
- Microbiology studies were conducted in a subset of patients.
Main Results:
- Consistent signs included lid disease, conjunctival redness, and inferior corneal vascularization.
- Microbiology identified coagulase-negative staphylococcus and Propionibacterium acnes.
- All patients experienced symptom relief within weeks, with progressive ocular surface improvement over two months, despite frequent reactivations.
Conclusions:
- Childhood blepharokeratoconjunctivitis presents as a chronic inflammatory condition with diverse manifestations.
- Treatment with oral erythromycin and topical steroids is effective for symptom resolution and clinical improvement.
- The chronic nature necessitates ongoing management due to frequent recurrences.
Purpose:
To describe the history, symptoms, and clinical signs and discuss the treatment of blepharokeratoconjunctivitis.
Methods:
Eight children (five girls and three boys), ranging in age from 3.5-13 years, were clinically diagnosed with blepharokeratoconjunctivitis. Microbiology studies were performed in four of the eight children. Treatment consisted of lid hygiene, oral erythromycin suspension, and preservative-free steroids. Duration of therapy was directed by clinical improvement.
Results:
Average age at onset was 3.2 years (range: 0.5-8 years). Lid disease, conjunctival redness, and inferior superficial corneal vascularization were consistent features (100%). Other signs were punctate corneal epithelial staining, inferior subepithelial vascularization and infiltrate, conjunctival phlyctenules, corneal phlyctenules, and circumferential pannus. Microbiology testing demonstrated coagulase-negative staphylococcus and Propionibacterium acnes. Average follow-up was 8.3 months (range: 2-23 months). All patients had relief of symptoms within 2-3 weeks. Clinical signs took more time to regress but all had progressive improvement of the ocular surface by 2 months. Blepharokeratoconjunctivitis reactivated in all patients during follow-up, and repeat therapy was administered.
Conclusion:
Blepharokeratoconjunctivitis in childhood is a chronic inflammatory process that can have different presentations. It can be successfully treated with oral erythromycin and topical steroids.
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