Atopic keratoconjunctivitis is a chronic inflammation of the eyelids and conjunctiva (a membrane that covers the white of the eye and inside of eyelids). It is characterized by redness and lesions of the eyelids and severe itching of the eyes. Left untreated, it can lead to severe visual impairment.

Although it can occur at any age, atopic keratoconjunctivitis often appears during late adolescence or early adulthood. The eye allergy is associated with atopic dermatitis, a form of eczema associated with allergies. Typically, red lesions appear on the eyelids, which then begin to ooze, crust and scale. In severe cases, patients are extremely sensitive to light, and damage to the cornea (the eye's outermost layer) or cataracts (a clouding of the lens of the eye) may occur. Atopic keratoconjunctivitis is similar to vernal conjunctivitis, but there are key differences in symptoms that separate the two conditions.

To prevent long-term vision damage, patients with atopic keratoconjunctivitis must seek treatment. Medications such as corticosteroids, antihistamines, antibiotics (to treat any bacterial infection that develops) and cromolyn sodium can be used to effectively treat the condition.

Atopic keratoconjunctivitis is a form of atopic dermatitis (eczema associated with allergies) that affects the eyelids and conjunctiva (the membrane covering the white of the eye and inner eyelid). This chronic eye allergy can damage the cornea (the eye's outermost layer) and cause permanent vision damage if left untreated.

Most people with atopic keratoconjunctivitis have symptoms of atopic dermatitis elsewhere on their bodies. However, the area around the eyes usually manifests the most severe symptoms, which include red, thickened eyelids, eye itchiness and small papular lesions (solid elevations of skin) that ooze, crust and scale. Excess tearing and extreme sensitivity to light (photophobia) also may occur. In rare cases, Horner-Trantas dots (localized collections of white blood cells known as eosinophils) also may appear at the limbus (junction of the eyeball’s cornea and sclera).

Atopic keratoconjunctivitis typically first appears in the teens through early 20s, but it can occur into middle age. It is more common in males than females. Patients often have a personal history of allergy, especially allergic rhinitis (hay fever), eczema and/or asthma. A family history of multiple allergies is also common.

It is closely related to allergic rhinoconjunctivitis and may coexist with the condition. The biggest difference between the two conditions is that atopic keratoconjunctivitis is chronic and potentially threatens a patient’s sight, whereas allergic rhinoconjunctivitis is rarely sight-threatening and tends to flare up in tandem with a patient’s symptoms of allergic rhinitis.

Atopic keratoconjunctivitis is one of four major ocular (eye) allergies that are closely related to one another. All four are associated with inflammation of the eyes and surrounding tissues, but each has their own distinguishing characteristics:

• Allergic rhinoconjunctivitis. Also known as “hay fever conjunctivitis,” or “allergic conjunctivitis,” it occurs when allergens such as pollen, mold, pet dander or dust mites trigger an allergic response that inflames the conjunctiva (a membrane that covers the white of the eye and inside of eyelids). Symptoms include itchiness, clear discharge and redness of the eye. Swelling of the surrounding tissues is also likely. This is usually diagnosed when symptoms appear in tandem with allergic rhinitis.
  
  
• Contact keratoconjunctivitis. A form of contact dermatitis that usually occurs when the eye reacts to an eyedrop, cosmetic or allergen transferred from the hand to the eye through rubbing or another action.
  
  
• Vernal conjunctivitis. A sight-threatening inflammation of the membrane covering the back of the eyelid (tarsal conjunctiva). It primarily affects children younger than 14, and at least twice as many boys as girls have the condition. Allergens that come into contact with the eye are believed to be at the root of the condition. It affects both eyes (bilateral) and occurs most often in hot, dry climates during the spring and summer. 

Atopic keratoconjunctivitis shares many characteristics with vernal conjunctivitis. However, there are some key differences:

* Gelatinous, white clumps of degenerated eosinophils
^ Proliferation of blood vessels in abnormal quality

Other related disorders include:

• Atopic dermatitis. A disorder of the upper layers of the skin that usually begins in childhood. It typically affects those in families with a history of atopic dermatitis, allergic conditions or asthma. Scaly, itchy skin rashes are typical symptoms of the disorder, which is the most severe and longest-lasting form of dermatitis. Atopic keratoconjunctivitis is associated with atopic dermatitis of the eyelid and face.
  
  
• Contact dermatitis. Any inflammation that occurs on the skin’s surface after coming into contact with an allergen or irritant. While uncomfortable, the condition is usually not serious, though it should not be left untreated. Contact dermatitis is the most common source of work–related diseases.
  

  

• Allergic rhinitis (hay fever). An inflammation of the inner lining of the nose that occurs when an allergic individual encounters an airborne allergen such as pollen, mold, dust mites or animal dander. Many people with atopic keratoconjunctivitis also suffer from allergic rhinitis.
  
  
• Asthma. A chronic inflammation of the body’s bronchial (airway) tissues that afflicts millions of people in the United States. An asthma attack occurs when exposure to allergens or other stimuli further inflame the airways, leading to an inability to expel trapped air from the lungs. Many people with atopic keratoconjunctivitis also suffer from asthma.

Severe itching of the eyes is the major symptom of atopic keratoconjunctivitis. Although the condition is considered to be a perennial (year-round) disorder, the itching tends to worsen for some patients during certain seasons (particularly winter). As the disease progresses, severe vision loss can occur. The precise reason for this is not clear.

Bacterial infections can also develop from atopic keratoconjunctivitis. Symptoms that indicate an infection include sudden increase in the redness of the eyelid margin (edge). Discharge from the margin also may indicate an infection.

Other symptoms associated with atopic keratoconjunctivitis include:

• Stringy eye discharge
• Mucus discharge from the eye
• Red, oozing lesions around the eyes
• Excess tearing
• Blurred vision
• Increased sensitivity to light (photophobia)
• Eye burning and pain
• Inflammation of the conjunctiva (the membrane that covers the white of the eye and the inside of the eyelids)
• Fissuring (a break or slit) of the eyelid
• Hardening of the eyelid

Individuals exhibiting one or more of these symptoms should consult a physician. Left untreated, atopic keratoconjunctivitis can lead to scarring, corneal ulcers, cataracts (a clouding of the lens of the eye), keratoconus (a disease characterized by the gradual thinning and bulging of the cornea into a cone-like shape) and corneal vascularization (abnormal or excessive formation of blood vessels in the cornea).

A medical history and physical examination are crucial to properly diagnosing atopic keratoconjunctivitis. A diagnosis of atopic keratoconjunctivitis is more likely if a patient has a family history of atopic disease (inherited allergy-related disease) in one or both parents. Other atopic disorders in the patient (for example, asthma or allergic rhinitis) also are indicators of atopic keratoconjunctivitis.

Healthcare professionals usually can recognize atopic keratoconjunctivitis from its appearance. Doctors will first anesthetize the eye and then use scrapings of the conjunctiva (a membrane that covers the white of the eye and inside of eyelids) or collect secretions and discharge to check for the presence of eosinophils. This is a type of white blood cell that releases some of the major chemical mediators (the substances that cause inflammation of airways) during an asthma attack. 

Treatment of atopic keratoconjunctivitis takes several forms. Antihistamine creams are used to provide temporary relief of eye symptoms. Corticosteroid creams are often used for limited periods to treat the dermatitis of the outer eyelid. Long term use of corticosteroids is not recommended. Patients must be careful to avoid getting this medication into the eye itself.

Antibiotics may be prescribed to treat bacterial infections that sometimes develop. Cromolyn sodium eyedrops are used to treat inflammation of the conjunctiva. Cold compresses and saline irrigation may also provide relief from symptoms.

In addition, patients may be advised to wear cotton gloves at night to prevent unintentional damage to the eye caused by rubbing or scratching during sleep.

Patients with a history of atopic keratoconjunctivitis are urged to avoid allergens that trigger symptoms. Avoidance is the only successful prevention technique for those with atopic keratoconjunctivitis.

Allergy shots (immunotherapy) are generally not considered a good option for treating atopic keratoconjunctivitis. It is often difficult for a patient to build a tolerance to all of the allergens that trigger symptoms. In addition, some evidence suggests that the conjunctiva is not as responsive to desensitization treatments as the skin or the lungs.

Patients in the later stages of atopic keratoconjunctivitis may require surgery to address complications. For instance, patients with cataracts may require intraocular lens implantation.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctors the following questions related to atopic keratoconjunctivitis:

1. Do my symptoms indicate atopic keratoconjunctivitis?
   
   
2. What methods will you use to determine if I have atopic keratoconjunctivitis?
   
   
3. How did I get this condition? What exactly is causing it?
   
   
4. What treatments are available to me? How effective are they?
   
   
5. Am I at risk for vision loss?
   
   
6. When can I expect my symptoms to subside?
   
   
7. Am I likely to develop atopic keratoconjunctivitis again?
   
   
8. How can I lower my risk of having this condition again?
   
   
9. Can I continue to wear contact lenses?
   
   
10. Are my children likely to develop this condition as well?