Characterizing pediatric blepharokeratoconjunctivitis in an underserved urban setting

Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic inflammatory disease of the eyelid margin with secondary conjunctival and corneal involvement. The purpose of this study was to characterize the clinical features, visual outcomes, and treatment of PBKC in a diverse, underserved metropolitan community in the United States.

A retrospective study was conducted of patients 16 years old or younger diagnosed with PBKC, who were identified using relevant Systematized Nomenclature of Medicine - Clinical Terminology (SNOMED CT) codes and manual chart review.

A total of 60 patients were included. Most patients were female 35 (58%) and identified as Hispanic or Latino 33 (55%). Bilateral involvement was observed in 38 patients (63%). The most common symptoms were eye redness 52 (87%), recurrent chalazia 38 (63%), tearing 30 (50%), and ocular itching 30 (50%). All patients had concurrent lid, conjunctival, and corneal involvement. Based on corneal findings, 15 (25%) had mild, 34 (57%) moderate, and 11 (18%) severe disease, with 8 (73%) of severe cases being Hispanic. Mean age at corneal involvement was 8.3 years old, with moderate and severe cases occurring about 3 years earlier than mild ones. Amblyopia only occurred in moderate-to-severe cases 11 (18%). Final visual acuity varied by severity, with improvement in moderate disease and decline in severe cases. Recurrence was observed in 37 (62%) patients, especially in severe cases 11 (100%). Severe patients received topical antibiotic or combination antibiotic/steroid drops and ointments 11 (100%), topical steroid drops 9 (82%), and oral antivirals 4 (36%) more frequently than other groups.

The high rates of corneal complications, visual impairment, and disease recurrence in our underserved urban cohort suggest the importance of early diagnosis and consistent follow-up.