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Thomas H Dohlman, Buntitar Lertsuwanroj, Jessica Ciralsky; Management of Pediatric Blepharokeratoconjunctivitis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):986.
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© ARVO (1962-2015); The Authors (2016-present)
Blepharokeratoconjunctivitis (BKC) in children is frequently misdiagnosed as herpetic keratitis, allergic conjunctivitis or viral conjunctivitis. A delay in diagnosis can be devastating as significant visual impairment can occur from ongoing untreated corneal inflammation and resultant corneal scarring. Once an accurate diagnosis is made, treatment must be started promptly with lid hygiene, topical anti-inflammatories and oral antibiotics. Several oral antibiotic regimens have been described with varied agents, dosages, and durations of treatment. In this case series, we describe the successful treatment of four children with severe BKC with high dose oral Azithromycin for three months.
A retrospective case series review of children diagnosed with BKC between 2009 and 2015 were identified. Patients’ clinical history, presenting symptoms and clinical signs at the time of diagnosis were reviewed, as were treatment choice, efficacy and adverse events associated with treatment.
Four pediatric patients (3 female, 1 male) with BKC were identified. The average age of disease onset was 4.25 years (range 3-6 years) while the average age of presentation was 6 years (range 3-11 years). In terms of clinical symptoms, patients most commonly presented with eye redness (100% of patients), photophobia (75%), and pain (25%). On slit-lamp examination, all patients had blepharitis in both eyes and corneal pathology in only one eye. Of the four eyes with corneal pathology, 100% had corneal scarring, 75% had corneal thinning, and 50% had corneal neovascularization. Patients were treated with a three month course of oral azithromycin (10-15 mg/kg/day) and topical steroids in the eye with corneal pathology. The average time to disease resolution for all patients was 2.5 months (range 1-4 months). No eyes in this series lost best-corrected visual acuity. There were no adverse effects associated with treatment and there were no recurrences of BKC during the mean follow-up of 6 months.
BKC is an important disease to recognize and treat early as a delay in diagnosis can lead to significant corneal pathology and resultant visual loss. High dose oral Azithromycin and topical anti-inflammatories should be considered for the treatment of children with severe BKC and corneal pathology.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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