Atopic Keratoconjunctivitis: Pathophysiology, Clinic, and Potential New Therapeutic Concepts

Abstract

Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease with a bipolar age distribution in childhood, adolescence and middle adulthood. Up to 50% of AD patients show ocular involvement, which can be potentially sight threatening. Clinically, the majority of cases present with atopic blepharo(kerato)conjunctivitis or atopic keratoconjunctivitis (AKC); other clinical variants from this group of inflammatory ocular surface diseases are keratoconjunctivitis vernalis in childhood and adolescence and allergic conjunctivitis. In addition to the aforementioned blepharitis, keratitis and conjunctivitis, AD is also associated with eyelid involvement with subsequent eyelid malposition, limbal insufficiency with the development of pseudopterygia, (chronic) cicatrizing conjunctivitis with symblephara formation and fornix shortening, as well as ocular surface malignancies such as conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma. In addition, an association with AD or AKC has been described for keratoconus. Whereas the therapy of AD in dermatology has made revolutionary advances in recent years through the use of biologicals, the primary use of these biologicals in ophthalmological complications is still very hesitant. Treatment here is often provided using topical steroids and calcineurin inhibitors. The following article summarises recent developments in basic and clinical dermatological research and discusses them in the context of current concepts for ophthalmological therapy.

Conclusion

Dermatological Conclusion

• AD is widespread, especially in developed countries, affecting up to 25% of children and 10% of adults.

• Genetically determined skin barrier defects predispose affected individuals to inflammation and consecutive superinfections (in particular with Staphylococcus aureus).

• The localization and symptoms vary depending on age and include severe itching, erythema, and lichenification.

• Standard treatment includes basic therapy and topical immunomodulators.

• A variety of new systemic immunomodulators are now available for diseases stages that do not respond to topical treatment.

Ophthalmological Conclusion

• Involvement of the ocular surface and periocular adnexa in the form of AKC is very common in AD patients, occurring in over 50% of cases.

• If left untreated, AKC can lead to loss of vision.

• Treatment depends on the ophthalmological findings – if topical steroids and topical CsA are insufficient, an appropriate systemic treatment must be evaluated in consultation with the treating dermatologist.

Future developments in pharmacotherapy give cause to hope that the spectrum of available topical drugs will be expanded.

Keywords

atopic dermatitis - atopic keratoconjunctivitis - atopy

Publikationsverlauf

Eingereicht: 29. Oktober 2023

Angenommen: 08. Januar 2024

Artikel online veröffentlicht:
11. April 2024

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