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Visual outcome and corneal changes in children with chronic blepharokeratoconjunctivitis
Sophie M Jones1, Joel M Weinstein, Phillippa Cumberland
1Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom.
Insights
Chronic blepharokeratoconjunctivitis (BKC) can cause significant vision loss in children, especially with delayed treatment. Early intervention with topical and systemic therapies, including flaxseed oil, improves visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Corneal Diseases
Background:
- Chronic blepharokeratoconjunctivitis (BKC) is an inflammatory eye condition affecting children.
- BKC can lead to significant corneal involvement and visual impairment.
Purpose of the Study:
- To investigate the causes, management strategies, and visual outcomes of BKC in pediatric patients.
- To evaluate the impact of delayed treatment on visual function.
Main Methods:
- Retrospective case series of 27 children diagnosed with BKC.
- Data collected included presenting visual acuity, refractive error, and corneal/eyelid pathology.
- Treatment involved lid hygiene, topical/systemic antibiotics, steroids, and amblyopia therapy; flaxseed oil was used as an alternative to long-term antibiotics.
Main Results:
- Most patients presented with discomfort, conjunctival injection, and posterior blepharitis; 81% had corneal involvement.
- Best-corrected visual acuity (BCVA) improved in 70% of affected eyes after treatment (median logMAR from 0.28 to 0.02).
- Delayed treatment (2-year lag) was associated with reduced final BCVA; 48% of patients had amblyopia.
Conclusions:
- Significant visual loss can occur in pediatric BKC, emphasizing the need for prompt diagnosis and management.
- Comprehensive treatment including topical and systemic therapies is crucial.
- Flaxseed oil shows promise as an anti-inflammatory alternative to prolonged antibiotic use.
Objective:
To describe the cause, management, and effect of chronic blepharokeratoconjunctivitis (BKC) on the cornea and visual function in children.
Design:
Noncomparative, interventional, retrospective case series.
Participants:
Twenty-seven children with BKC.
Methods:
Presenting age, best-corrected visual acuity (BCVA), refractive error, and any corneal or eyelid pathologic features were recorded. Treatment included modified lid hygiene, topical antibiotics, and steroids. Systemic therapy included oral antibiotics and, from 2003 onward, flaxseed oil as an alternative to long-term antibiotics. Amblyopia therapy included refractive correction, occlusion, or atropine therapy.
Main Outcome Measures:
Corneal and eyelid status, visual acuity (VA), and refractive error at final examination.
Results:
Mean age at presentation was 6.9 years (range, 7 months-15.9 years), and mean follow-up was 2.3 years (range, 5 months-6.1 years). All patients had discomfort, conjunctival injection, and signs of posterior blepharitis at presentation. Photophobia was reported in 14 patients (52%), whereas anterior eyelid inflammation was noted in 6 (22%). Acne rosacea was confirmed in 3 patients (11%). Corneal involvement occurred in 44 eyes (81%), and a history of recurrent chalazia was seen in 18 patients (67%). Median monocular BCVAs in affected eyes were 0.28 logarithm of the minimum angle of resolution (logMAR) units (interquartile range [IqR], 0.02-0.40) at presentation and 0.02 logMAR units (IqR, 0.00-0.18) at last visit. Best-corrected VA improved in 70% of affected eyes and remained unchanged in 30%. Superimposed amblyopia was present and treated in 15 patients (48%). All 8 patients (20%) who failed to achieve VA of 0.2 logMAR units or better at the final examination had bilateral corneal involvement at presentation. One child experienced a systemic side effect from oral antibiotics. No child had significant side effects from topical treatment. Twelve patients (44%) received flaxseed oil as part of their tapering regimen. A 2-year lag between symptom onset and treatment resulted, on average, in a reduction of 0.06 logMAR units of VA (95% confidence interval, 0.00-0.12; P = 0.054).
Conclusions:
These findings suggest that visual loss may be significant in BKC and that delayed treatment may result in decreased final BCVA. Adequate management needs both topical and systemic treatment. Flaxseed oil may be an effective antiinflammatory nutritional therapy alternative to long-term antibiotics.
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