Clinical spectrum of pediatric blepharokeratoconjunctivitis

To evaluate the incidence, symptoms, clinical signs, and therapy instituted in children with blepharokeratoconjunctivitis (BKC).

In this observational, retrospective case series, we reviewed all medical records of pediatric patients presenting to the ophthalmology clinic at the Kalawati Saran Children's Hospital, New Delhi, India from 2003 to 2006. History, clinical characteristics, and treatment protocol were noted, as well as reason for presentation/referral and subsequent diagnosis.

Of 5,012 pediatric patients, 615 (12%) demonstrated features of BKC. Boys were more commonly affected (62%) than girls. The mean age at presentation was 6.7 years (range, 7 months to 16 years). Lid involvement and conjunctival congestion were consistent features. Anterior (seborrheic variety) blepharitis was seen in nearly half the children (302), followed by chalazion (18%), external hordeolum (17%), ulcerative anterior blepharitis (6%), phlyctenular keratoconjunctivitis (6%), and marginal ulcerative keratitis (2%). Refractive error was evident in 521 of 615 children (85%) with BKC. All patients were treated with daily eyelid hygiene, warm compresses, and topical antibiotics. Corticosteroid drops were prescribed in 14% and oral erythromycin in 23%.

BKC was the commonest diagnosis at consultation among all pediatric referrals. Anterior blepharitis was more common than posterior blepharitis. Severe cases with corneal involvement accounted for only 5% of the disease spectrum.