About Atopic Keratoconjunctivitis (AKC)

Overview

Atopic keratoconjunctivitis (AKC) is a rare but serious eye condition. It is a long-lasting inflammation that affects both eyes and can involve not only the eye surface but also the eyelids, which is why it is sometimes called blepharokeratoconjunctivitis. AKC is linked to atopic dermatitis (a type of skin allergy) and is considered the most severe form of chronic allergic conjunctivitis. It typically presents with symptoms such as increased sensitivity to light, itching and burning eyes, and blurred vision. AKC commonly occurs in individuals with a personal or family history of atopic dermatitis or other allergic diseases like eczema, asthma, or urticaria (hives). AKC is most common in people between 20 and 50 years old, with a higher incidence in males. Without treatment, AKC can lead to complications such as corneal ulcers, thinning and bulging of the cornea (keratoconus), and blood vessel growth into the cornea (corneal vascularization).

Causes and Risk Factors

While the exact root cause of AKC is not fully understood, it is believed to be related to an abnormal immune response in individuals with a genetic tendency to allergies. The immune system overreacts to certain triggers, leading to inflammation in the conjunctiva and cornea.

Non-modifiable risk factors for AKC cannot be changed or controlled. These include:

• Family history: Having a family history of atopic diseases such as eczema, asthma, or allergic rhinitis increases the risk of developing AKC.

Modifiable risk factors for AKC can be influenced or changed. These include:

• Allergens: Exposure to allergens such as pollen, dust mites, pet dander, or certain foods can trigger AKC symptoms. Avoiding or minimizing exposure to these allergens may help reduce the risk.
• Eye rubbing: Excessive eye rubbing can worsen AKC symptoms and increase the risk of complications. It is important to avoid rubbing the eyes and use gentle techniques to manage itching or discomfort.
• Environmental factors: Environmental pollution, particularly tiny particles in the air, has been associated with an increased prevalence of AKC. Minimizing exposure to polluted environments may be beneficial.
• Contact lens use: Contact lens wearers have a higher risk of developing AKC due to potential irritation and increased susceptibility to allergens. Proper hygiene and regular check-ups with an eye care professional are important for contact lens wearers.

It's important to note that while these risk factors may contribute to the development or exacerbation of AKC, individual experiences may vary. It is always recommended to consult with an eye care professional for personalized advice and management strategies.

Symptoms

The most common early symptoms of AKC include increased sensitivity to light, itching and burning eyes, and blurred vision. As the condition progresses or reaches higher severity, additional symptoms may occur. These can include:

• Redness: The eyes may appear red or bloodshot.
• Swelling: The eyelids may become swollen and puffy.
• Excessive tearing: The eyes may produce excessive tears.
• Discharge: There may be a sticky or watery discharge from the eyes.
• Dryness: The eyes may feel dry and irritated.
• Blurred vision: Vision may become blurry or hazy.
• Foreign body sensation: It may feel like there is something in the eye.
• Corneal scarring: If left untreated, AKC can lead to scarring on the cornea.

Remember, if you experience any of these symptoms or suspect you have AKC, it is important to consult a doctor for proper diagnosis and treatment.

Diagnosis

To diagnose AKC, the following examinations, tests, and procedures are commonly performed:

• Physical exam: The healthcare provider will look for physical signs of the condition, such as redness, swelling, and itching in the eyes.
• Medical history: Gathering information about your symptoms, previous diagnoses, and allergies can help in making an accurate diagnosis.
• Slit-Lamp examination: This specialized microscope allows the healthcare provider to examine the front part of your eye in detail. It helps identify specific features of AKC.
• Allergy testing: Allergy tests may be conducted to determine if specific allergens are triggering your symptoms. These tests can include skin prick tests or blood tests.

To determine the severity of AKC, additional examinations and tests may be recommended:

• Visual acuity test: This test measures how well you can see at various distances to assess any vision loss caused by the condition.
• Tear film evaluation: The healthcare provider may check how much and how well your tears work to see if they’re keeping your eyes properly moist.
• Corneal topography: This test maps the curvature and shape of your cornea to identify any irregularities caused by AKC.
• Conjunctival biopsy: In some cases, a small sample of conjunctival tissue may be taken for further analysis to confirm the diagnosis or determine the severity of the condition.

Remember, these are general examinations, tests, and procedures. Your healthcare provider will determine which ones are necessary based on your specific situation.

Treatment Options

The goals of treatment for AKC are to alleviate symptoms, reduce inflammation, and prevent complications.

Here are the different types of medications, therapies, therapeutic procedures, prevention, and other treatments recommended for AKC and how they work to achieve treatment goals:

• Medications:
  • Topical antihistamines or mast cell stabilizers: These medications help reduce itching and allergic reactions in the eyes.
  • Preservative-free lubricating gels and ointments: These provide moisture to the eyes and relieve dryness.
  • Topical nonsteroidal anti-inflammatory (NSAID) agents: They help reduce inflammation in the eyes.
  • Topical corticosteroids: These medications are used for severe cases to reduce inflammation and control symptoms.
• Therapies:
  • Punctal plugs: These are tiny devices that can be inserted into the tear ducts to prevent tears from draining too quickly, thus reducing dry eye symptoms.
• Therapeutic procedures:
  • Surgical options: For severe cases of AKC or complications like herpetic keratoconjunctivitis (an infection of the cornea caused by the herpes virus) or neurotrophic keratoconjunctivitis (damage to the cornea due to nerve issues), surgical interventions like a corneal transplant may be considered.
• Prevention:
  • Allergy testing: This can help identify specific allergens that trigger AKC symptoms, allowing for focused steps to avoid them.
• Treating underlying conditions:
• If AKC is associated with an underlying viral infection or autoimmune/genetic condition, appropriate treatment for those conditions is necessary.

It's important to consult with a healthcare professional before starting any medication or treatment. They can provide personalized advice based on your specific condition and needs.

Medication dosing may be affected by many factors. Check with your healthcare professional about dosing for your individual situation. Side effects can occur. Check with your healthcare professional or read the information provided with your medication for side effect information.