Abstract
Purpose :
Blepharokeratoconjunctivitis (BKC) can result in significant visual morbidity and reduced quality of life in pediatric patients but traditional treatments for severe disease including topical steroids and doxycycline are associated with complications. We performed a retrospective, observational study to evaluate the clinical characteristics and outcomes of pediatric patients with BKC treated with a regimen of short-term topical steroid combined with short-term and/or long-term topical or oral azithromycin.
Methods :
A chart review of all patients diagnosed with BKC by the cornea service at our institution between 2018 and 2021 was conducted. Data collected included demographics, comorbidities, presenting signs and symptoms, and treatment modality. Clinical improvement and recurrence after treatment completion was assessed. Patients with concomitant ocular surface disease including HSV, exposure keratopathy and vernal keratoconjunctivitis were excluded.
Results :
25 patients with BKC were identified. 80% were female. The average age at first cornea evaluation was 9 years. The most common presenting symptoms were conjunctival hyperemia (64%) and recurrent eyelid masses (36%). The most common exam findings were meibomian gland dysfunction (88%), corneal neovascularization (56%), conjunctival injection (52%), and anterior stromal corneal opacities (48%). Sixteen of 25 patients (64%) were treated with at least one month of either topical azithromycin or oral azithromycin combined with at least two weeks, but no more than 6 weeks, of topical steroid. One patient was excluded due to lack of follow-up. All patients experienced resolution of symptoms after completion of treatment (P<0.001). Corneal neovascularization resolved or markedly improved in 14 of 18 eyes (7 patients, 77.7%, P<0.001)). Mean presenting visual acuity (VA) was 20/50 and mean post-treatment VA was 20/30 (p=0.251). There was a 35.7% recurrence rate but symptoms resolved with re-initiation of treatment and long-term continuation of topical or oral azithromycin.
Conclusions :
Our treatment regimen is effective in managing pediatric BKC and reduces long-term use of topical steroid. Early referral and treatment can improve and maintain VA. Patients must be followed long-term given the risk of recurrence and potential impact on vision and amblyopia. Recurrences can be managed with long-term treatment.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.