Atopic Keratoconjunctivitis - AKC

What is Atopic
Keratoconjunctivitis (AKC)?

Atopic keratoconjunctivitis (AKC) is a chronic allergic eye condition and causes inflammation of the eyelids, conjunctiva, and cornea.^{1, 2} When the cornea becomes involved, leaky and weak blood vessels can develop on the previously clear surface, causing scarring and decreased vision. AKC usually develops in the late teens and early adulthood.¹AKC is quite rare and only occurs in <1-8% of the population.²

Signs & Symptoms

Eyelid Redness and Itching
Eye Redness
Tearing/Watery Eyes
Light sensitivity
Itchy and burning eyes¹
Blurry vision³
Eczematous, thickened, crusty eyelids^{2, 4}
Mucous discharge²

Important Note on AKC

Signs and symptoms of AKC can vary in severity. There may be signs that are not noticed by patients and require an eye care practitioner to diagnose (IE. Keratitis).

What causes AKC?

AKC is genetic and is usually associated with atopic disease, including atopic dermatitis, eczema, asthma, and food and environmental allergies, including a family history of allergies and hay fever.^{1, 3}

Atopy consists of a heightened immune response to allergens.¹More specifically, atopic dermatitis is a chronic and progressive skin condition that causes symptoms of dry, itchy, red, cracked, or scaly skin. AKC is present in 25-40% of patients with atopic dermatitis, but atopic dermatitis is present in 95% of AKC patients.² Decreased tear volumes are examined in patients with AKC, which results in signs and symptoms of dry eye and eye surface inflammation.⁵

Risk factors:

Food and environmental allergies/sensitivities at a young age
Asthma
Increased exposure to pollutants (IE., Living in a densely populated city)
Tobacco smoke
Antibiotic use
Obesity³

How is AKC diagnosed?

Ophthalmic examination: by an eye doctor, where they will also consider the patient’s symptoms and medical history in the diagnosis.

Serum IgE testing: cannot specifically diagnose AKC, but can determine the presence of an atopic condition.

Brush cytology: sample taken from the inside of the eyelid with a brush (looks like a mascara wand), determines the density of inflammatory cells.

Confocal scanning laser microscopy: determines density of inflammatory cells; less invasive vs. brush cytology.³

Atopic keratoconjunctivitis may be misdiagnosed as allergic conjunctivitis, vernal conjunctivitis, eye rosacea, or giant papillary conjunctivitis (GPC), as signs and symptoms can be similar.³Patients with atopic keratoconjunctivitis have associated atopic conditions, like atopic dermatitis, eczema, hay fever, or food/environmental allergies.^{1, 3}

How is AKC treated?

Cold compresses (mild cases): can be used as relief when a patient feels the urge to itch their eyes. Consistent eye itching and rubbing can cause thinning of the cornea, leading to keratoconus (corneal disease caused by the steepening and thinning of the cornea).

Eye lubricants (mild cases): artificial tear drops to soothe the eye surface and replenish the tear film.²

Anti-histamines (mild cases): topical eye drops (IE. Zaditor® or Alaway®, relieves itchiness) and oral medication.

Mast cell stabilizers (mild cases): topical eye drops (IE. Pataday®, relieves itchiness).

Steroids: topical eye drops (moderate cases) or oral medication (severe cases).³

Tacrolimus or Cyclosporine (moderate-severe cases): topical eyelid ointment or oral forms; immunosuppressants.^{2, 3, 6}

Living with AKC

In even mild cases of atopic dermatitis, eye examinations should be maintained as recommended by an eye care provider, along with an allergist or dermatologist. Eye complications can occur quickly in patients with AKC.

AKC can be quite debilitating for some patients. AKC increases the risk of developing corneal erosions and ulcers, which can cause significantly decreased vision. In severe cases, significant eye pain, scarring, and blindness can occur. Cataracts (opacification of the lens inside the eye) are more common in patients with AKC, as well.⁷ When diagnosed, it is important to follow management protocol by your eye doctor to prevent worsening of the condition.