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Atopic Keratoconjunctivitis

Last updated May 2, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Atopic Keratoconjunctivitis (AKC) is an infrequent, serious, and chronic condition that mostly affects individuals, who have a family history of allergic disorders, and who themselves (may) suffer from eczema, atopic rhinitis, or other environmental, food allergies.

What are the other Names for this Condition? (Also known as/Synonyms)

  • AKC (Atopic Keratoconjunctivitis)

What is Atopic Keratoconjunctivitis? (Definition/Background Information)

  • Atopic Keratoconjunctivitis (AKC) is an infrequent, serious, and chronic condition that mostly affects individuals, who have a family history of allergic disorders, and who themselves (may) suffer from eczema, atopic rhinitis, or other environmental, food allergies
  • AKC always involves both the cornea and conjunctiva of the lower eyelids. The symptoms do not clear spontaneously (unlike other Conjunctivitis forms) and the disorder could cause permanent eye damage and blindness, without treatment 
  • Conjunctivitis is inflammation of conjunctiva of the eye, which is the membrane covering the white region of the eye
  • In Conjunctivitis the white part of the eye turns red or pink, and hence it is known as Pink Eye. The infection may affect either one, or both the eyes, and is accompanied by inflammation, irritation, with watery discharge from the eyes. Under normal circumstances, Conjunctivitis does not affect vision. Atopic Keratoconjunctivitis is not infectious

Who gets Atopic Keratoconjunctivitis? (Age and Sex Distribution)

  • Atopic Keratoconjunctivitis typically occurs in late teens, young, and middle-aged adults (30-50 years old)
  • Men tend to be affected more than women

What are the Risk Factors for Atopic Keratoconjunctivitis? (Predisposing Factors)

The potential risk factors for Atopic Keratoconjunctivitis are:

  • An individual with a family history of allergies (like when parents are allergic to such allergens), is more prone to the condition
  • The presence of other allergy-related diseases or disorders (like atopic dermatitis, asthma, eczema) may trigger the condition. There is a wide, 20-95% chance that someone with such underlying conditions may be affected by AKC
  • Environmental or occupational exposure to allergy causing substances, such as animal dander, certain food ingredients, and dust mites

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Atopic Keratoconjunctivitis? (Etiology)

  • Atopic Keratoconjunctivitis is caused by exposure to external agents or particles that cause an allergic inflammatory response. An individual has to be allergic to that substance (either single or multiple allergens) to trigger the condition
  • When the allergen comes into contact with the conjunctiva and mucus membranes lining the eyes, the body releases histamine (an organic chemical) triggering the allergy symptoms. This is caused due to an extremely sensitive body immune system
  • The hypersensitive reaction of the body is thought to occur due to a morphological (anatomical) susceptibility to allergic conditions such as dermatitis, rhinitis, eczema, and asthma
  • Environmental factors and allergic substances include dust, animal dander, smoke, food chemicals, and other pollutants
  • Sometimes, non-specific elements like wind, heat/cold, may play a role in aggravating the allergic response

What are the Signs and Symptoms of Atopic Keratoconjunctivitis?

Signs and symptoms (mostly present throughout the year) of Atopic Keratoconjunctivitis include:

  • Severe itching and redness of the eye(s)
  • Eye pain and inflammation; with gritty feeling of sand-like particles inside the eye
  • Lower eyelids may show the presence of small nodules (papillae)
  • Continuous discharge of thick fluid from the eyes
  • Blurred vision, light sensitivity
  • Presence of cataract
  • AKC symptoms may worsen during certain seasons; especially in hot, cold seasons

How is Atopic Keratoconjunctivitis Diagnosed?

Atopic Keratoconjunctivitis is diagnosed as follows:

  • The ophthalmologist or physician performs a detailed eye examination; including a slit lamp or ophthalmoscope exam
  • Evaluation of the patient’s medical history; specifically the incidence of any other allergies, like asthma and rhinitis. The chronic nature of the condition (with a lack of seasonal variation) is noted
  • Blood analysis; to measure serum IgE level, eosinophil count
  • Examination of conjunctival scrapings; culture to rule out infectious cause
  • Differential diagnosis of other types of conjunctivitis should be considered, in order to eliminate other eye conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Atopic Keratoconjunctivitis?

Serious complications may arise if Atopic Keratoconjunctivitis is not treated. It is also dependent upon the presence of other secondary conditions (if any). The complications could include:

  • Severe corneal damage, scar, and perforation
  • Permanent damage to the eye, loss of vision (this has a high probability with late or no treatment)
  • Retinal detachment (peeling of the retina)
  • Bacterial or viral (herpes) infections can occur superimposed on AKC
  • Cataract, glaucoma; these are usually the side effects of various AKC treatment medications
  • Prolonged discomfort, mental and emotional stress

How is Atopic Keratoconjunctivitis Treated?

Atopic Keratoconjunctivitis requires rapid and intense methods to effectively control its potentially blinding effects. Specifically, the substance(s) responsible for an allergic trigger has to be identified and controlled, the symptoms treated, and body immune response system moderated. Some general management measures include:

  • Prior to the onset of symptoms, prophylactic measures are encouraged as a means of addressing the chronic (long-term) nature of AKC. These include the use of medications such as oral antihistamines, mast cell stabilizers (a non-steroid drug). These drugs are also used to prevent worsening of the condition
  • Other drugs to provide relief from symptoms are immunosuppressants, corticosteroids (prescribed in severe cases only), cyclosporine (to prevent recurrence of AKC), lubricating or anti-inflammatory eye-drops, and topical ointments
  • Avoidance of outdoor allergens and control of indoor allergy-inducing irritants should be considered. It is important that the specific allergen(s) be identified
  • Application of cold compress can help reduce discomfort
  • Immunotherapy (allergy shots) is used to desensitize the body and prevent it from overreacting to such external triggers. This method is usually considered, in case of a severe allergic attack that does not respond well to treatment, or when other medical disorders are also present
  • Suitable corrective surgery may be used to manage cataract, corneal injury, and eye inflammation
  • Avoid the use of contact lens during this period; wear eye glasses instead

How can Atopic Keratoconjunctivitis be Prevented?

  • Atopic Keratoconjunctivitis is a spontaneous body (eye) response to the presence of an allergen; it cannot be prevented, but only managed
  • Be aware of the allergy activating factor(s) and avoid such locations or situations, which provoke the body immune system to respond in such a manner. Also, learn to protect your eye from airborne particles (by using glasses)
  • In order to preserve the eye condition, always maintain hygiene and wash hands regularly. Prevent aggravation of the condition by staying out of the sun, keeping away from dust and smoke. Also avoid touching or rubbing the eyes (this may be difficult when the individuals are very young children)
  • Stop or restrain yourself from smoking tobacco, or drinking alcohol
  • Regular medical screenings at periodic intervals with physical examinations are mandatory, for those diagnosed with the disorder
  • Taking prophylactic medications are essential to prevent worsening of the eye condition

What is the Prognosis of Atopic Keratoconjunctivitis? (Outcomes/Resolutions)

  • Atopic Keratoconjunctivitis, without proper diagnosis and quick treatment could potentially cause blindness or partial loss of vision, due to corneal complications
  • Accurate diagnosis with prompt management of AKC can help avoid worsening of the condition and save the eyes from an irreversible damage

Additional and Relevant Useful Information for Atopic Keratoconjunctivitis:

  • Many alternatives medicine therapies, natural therapy, or home remedies are available to ease the discomfort of Allergic Conjunctivitis. However, such treatment methods are not a proven science and should not be substituted for a qualified healthcare provider’s medical advice

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 19, 2013
Last updated: May 2, 2018