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Blepharokeratoconjunctivitis in children: diagnosis and treatment
M Viswalingam1, S Rauz, N Morlet
1Corneal and External Diseases Service, Moorfields Eye Hospital NHS Trust, 162 City Road, London EC1V 2PD, UK.
Insights
Blepharokeratoconjunctivitis (BKC) in children is characterized by lid margin blepharitis, conjunctivitis, and keratitis. Treatment is effective, preventing vision loss, though severe cases are more common in Asian and Middle Eastern populations.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Corneal Diseases
Background:
- Blepharokeratoconjunctivitis (BKC) is an under-described pediatric ocular condition.
- Characterizing BKC is crucial for understanding its epidemiology, clinical presentation, and management in children.
Purpose of the Study:
- To characterize childhood Blepharokeratoconjunctivitis (BKC).
- To evaluate the epidemiology, clinical grading, and treatment strategies for pediatric BKC.
Main Methods:
- A cohort of 44 children diagnosed with BKC was followed for a median of 7 years.
- Diagnostic criteria included recurrent red eye, blepharitis, and keratitis.
- Clinical features were graded, and lid/conjunctival cultures were performed. Treatment involved lid hygiene, antibiotics, and corticosteroids.
Main Results:
- BKC was more severe in Asian and Middle Eastern children, with higher risks of specific keratitis types and ulcerations.
- Culture-positive lid swabs were found in 15 children.
- Most children showed symptom improvement with treatment, and disease progression after age 8 was uncommon.
Conclusions:
- BKC is defined as a syndrome involving blepharitis, conjunctivitis, and keratopathy in children.
- Pediatric BKC is prevalent in tertiary clinics, with more severe forms seen in Asian and Middle Eastern populations.
- Effective therapy can prevent vision loss in most cases of childhood BKC.
Aim:
Blepharokeratoconjunctivitis (BKC) is a poorly described entity in children. This study characterises this syndrome in childhood and evaluates epidemiology, clinical grading, and treatment strategies.
Methods:
44 children (20 white, 22 Asian, 2 Middle Eastern, median age 5.4 (range 1-14) years) with a diagnosis of BKC were followed for a median of 7 years. Diagnostic criteria included recurrent episodes of chronic red eye, watering, photophobia, blepharitis including recurrent styes or meibomian cysts, and a keratitis. Clinical features were graded as mild, moderate, or severe. The lids and conjunctiva were cultured. The treatment regimen incorporated lid hygiene, topical and/or systemic antibiotics, and topical corticosteroids.
Results:
The disease was most severe in the Asian and Middle Eastern children (p <0.001), who had a statistically higher risk of subepithelial punctate keratitis (p = 0.008), corneal vascularisation (p <0.001), and marginal corneal ulcerations (p = 0.003), than the white group. 15 children had culture positive lid swabs. Most children had a reduction in symptoms and signs with treatment, and progression of disease after the age of 8 was rare.
Conclusions:
BKC in children can be defined as "a syndrome usually associated with anterior or posterior lid margin blepharitis, accompanied by episodes of conjunctivitis, and a keratopathy including punctate erosions, punctate keratitis, phlyctenules, marginal keratitis, and ulceration." BKC is common in children in a tertiary referral corneal and external diseases clinic, with the more severe manifestations in the Asian and Middle Eastern populations. Therapy is effective and loss of sight can be prevented in most cases.
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