Abstract and Introduction
Abstract
Purpose of review: This review will focus on the diagnostic features of atopic keratoconjunctivitis (AKC), its relationship to atopic dermatitis, the immunopathogenesis, and therapy, and will include strategies used for the management of severe disease unresponsive to conventional therapy.
Recent findings: Recent research has demonstrated the importance of various cytokines (IL-33), proteins (thymic stromal lymphopoetin) and effector cells (conjunctival epithelial cells, eosinophils and basophils) in the pathogenesis of chronic ocular inflammation. Current evidence supports the use of tacrolimus and cyclosporin A, topically or systemically, as well tolerated and effective steroid sparing agents.
Summary: Recalcitrant AKC may be a blinding condition. Understanding the immunopathogenesis of atopic dermatitis and AKC has already influenced therapy and is essential to the development of future immunomodulatory treatments. The successful management of AKC requires the use of topical cromones, antihistamines and calcineurin inhibitors. Severely affected patients also require systemic immunosuppressive therapy. The current challenge is to find more specific topical and systemic immunomodulatory therapies with a better side-effect profile.
Introduction
The spectrum of atopic eye disease encompasses seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), atopic blepharoconjunctvitis (ABC), and giant papillary conjunctivitis (GPC). Common to these diseases are a papillary conjunctivitis and, with the exception of GPC, evidence of a type I, IgE-mediated, hypersensitivity response, although each disease entity has unique immunopathogenic pathways. These conditions have all been described as chronic allergic conjunctivitis (CAC).
Atopic keratoconjunctivitis was first described by Hogan in a group of highly atopic patients who developed chronic conjunctivitis, progressive corneal vascularization and scarring. Along with VKC, it is responsible for the blinding corneal complications of allergic eye disease.
In this review we summarize the diagnostic criteria for AKC, and its differentiation from other causes of CAC. We discuss some features of atopic dermatitis that are relevant to AKC and describe the clinical features and the immunology of the disease. Lastly we provide a synopsis of management strategies.