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Severe Blepharokeratoconjunctivitis in Children - the Toronto Experience: Pediatric Severe
Ramez Barbara1, Sina Khalili1, Diyaa Rachdan2
1Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Insights
Severe blepharokeratoconjunctivitis (BKC) in children can cause lasting vision loss. Early treatment and close follow-up are vital, as many patients require both topical steroids and systemic antibiotics, with a risk of flare-ups after treatment stops.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Corneal Diseases
Background:
- Severe blepharokeratoconjunctivitis (BKC) poses a significant risk of irreversible ocular morbidity and vision loss in pediatric patients.
- Understanding the clinical characteristics and treatment outcomes of severe BKC is crucial for effective management.
Purpose of the Study:
- To describe the clinical features and treatment results for a large group of children with severe BKC.
- To analyze factors influencing visual acuity and disease recurrence in pediatric BKC patients.
Main Methods:
- Retrospective cohort study of pediatric patients (under 18 years) with severe BKC treated between 2006 and 2021.
- Inclusion criteria included severe BKC with corneal involvement and a minimum six-month follow-up.
- Data analyzed included demographics, visual acuity, corneal pathology, antibiotic use, and flare-up rates.
Main Results:
- 197 pediatric patients (315 eyes) with severe BKC were identified, with a mean age of 7.6 years and female predominance.
- Corneal scarring (83%) and neovascularization (49%) were prevalent. Best corrected visual acuity improved significantly post-treatment (28% to 17%).
- 72% required systemic antibiotics; 23% experienced flare-ups post-treatment, primarily within the first year of cessation. 91% achieved complete response.
Conclusions:
- Severe BKC is a serious pediatric condition that can lead to significant vision impairment, particularly from central scarring and astigmatism.
- Prompt diagnosis and treatment are essential to minimize ocular morbidity.
- Close monitoring is necessary due to the risk of disease recurrence, especially after discontinuing systemic antibiotics.
Purpose:
To report on the clinical characteristics and treatment outcomes of a large cohort of pediatric patients who presented with severe blepharokeratoconjunctivitis (BKC).
Design:
Retrospective consecutive cohort study.
Subjects:
Patients aged under 18 years with BKC presented to the Cornea Service at the Hospital for Sick Children, Toronto, Canada, between 2006 and 2021.
Methods:
Children with severe BKC, defined as BKC with inflammation, new vessel formation, scarring, thinning and lipid deposits affecting the peripheral and/or central cornea, and a follow-up of at least six months were included. Basic demographics, best corrected visual acuity (BCVA), refractive error, disease laterality, type and duration of antibiotic therapy, flare-up rate and extent of corneal involvement were analyzed.
Main Outcome Measures:
BCVA, refraction, extent of corneal involvement, procedures, flare-up of BKC, and time to flare-up rate after cessation of systemic antibiotics treatment.
Results:
Out of 2,542 patients with blepharitis, 197 patients (315 eyes) were identified with severe BKC. The mean age at the first presentation was 7.6 years, with a 2:1 female predominance. At the presentation, 65% had a history of chalazion, and 28% had BCVA worse than 0.3 logMAR, which improved to 17% at final follow-up (p=0.007). The most striking corneal pathologies affecting the peripheral and central cornea were scarring (83%) and new vessel formation (49%). One hundred forty-two patients (72%) required systemic antibiotics (azithromycin, clarithromycin, erythromycin or doxycycline) of whom 23% experienced flare-ups requiring an escalation in treatment with topical steroids and/or systemic antibiotics, and 75% of these occurred within the first year of treatment cessation. Ninety-one percent of patients achieved complete response, defined as no disease activity and no use of topical steroids or systemic antibiotic treatment. Fifteen patients required surgical intervention.
Conclusion:
Blepharokeratoconjunctivitis is a serious disease in children, potentially causing irreversible ocular morbidity and vision loss. Central scarring and astigmatism can affect vision in a significant proportion of children. Therefore, early identification and treatment are necessary to reduce disease morbidity. Close follow-up is crucial as one in four patients may experience a flare-up, especially within the first year of treatment cessation. Most patients with severe BKC require both topical steroids and systemic antibiotics to control disease activity.
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