This document discusses the treatment of severe chronic atopic keratoconjunctivitis. It describes the signs and symptoms of the condition including tearing, photophobia, foreign body sensation, thick discharge, tarsal papillae, Horner-Trantas dots, and keratopathy. It recommends a treatment plan including sun-glasses, cool compresses, antihistamine and anti-inflammatory tablets, sodium cromoglicate eye drops, diluted steroid drops, lid hygiene, treating concurrent atopic diseases, and potentially deworming. However, the most effective modern therapies such as tacrolimus, cyclosporine, and surgery are not available in the local setting.

1. SEVERE CHRONIC ATOPIC
KERATOCONJUNCTIVITIS
Challenging Eye Allergy Cases: How to Tackle?

2. AKC OR VKC?
Vernal Keratoconjunctivitis: recurrent,
bilateral, allergic, primarily in boys before 10 yo;
remits in teens; severe in spring and summer,
mild symptoms throughout the year. May turn
into atopic form later
Atopic Keratoconjunctivitis: typical for
adults, bilateral, relentless, chronic, perennial
(not seasonal, as VKC), but can be worse in
winter
J.Kanski (Clinical Ophthalmology, 7th Ed.)

3. COMMON SYMPTOMS
Usual signs of allergy

4. COMMON SYMPTOMS
tearing, photophobia, foreign body
sensation, burning and thick
mucoid discharge
J.Kanski (Clinical Ophthalmology, 7th Ed.)

5. COMMON SIGNS Tarsal conjunctiva papillae or cobble stones
J.Kanski (Clinical Ophthalmology, 7th Ed.)

6. COMMON SIGNSHorner-Trantas Dots in Limbus
J.Kanski (Clinical Ophthalmology, 7th Ed.)

7. COMMON SIGNSKeratopathy
J.Kanski (Clinical Ophthalmology, 7th Ed.)
(A) Superior punctate
erosions and sheets of
mucus; (B) macroerosion;
(C) early plaque formation;
(D) plaque and ‘shield’
ulcer; (E) oval subepithelial
scarring; (F)
pseudogerontoxon and
limbal papillae

8. COMMON SIGNS18 YO GIRL AND BOY WITH SEVERE CASES

9. HOW WE CAN HELP?
1) SUN-GLASSES

10. HOW WE CAN HELP?
2) COOL WET COMPRESSES
FREQUENTLY

11. HOW WE CAN HELP?
3) ANTIALLERGIC TABLETS:
WHAT IS THE
DOSAGE?

12. HOW WE CAN HELP?
3) ANTIALLERGIC TABLETS:
CHLORPHENAMINE MALEATE (“PIRITON”,
ANTIHISTAMINE DRUG)
>12 YO - 1 TABLET 4 TO 6 HOURLY (!),
NOT EXCEEDING 6 TABLETS PER 24HRS
6-12 YO – ½ TAB 4-6 HOURLY
PREGNANCY: NOT RECOMMENDED
https://www.medicines.org.uk/emc/medicine/16103

13. HOW WE CAN HELP?
4) ANTIALLERGIC EYEDROPS:
WHAT IS THE DOSAGE?

14. HOW WE CAN HELP?
4) ANTIALLERGIC EYEDROPS:
SODIUM CROMOGLICATE
1 DROP 4 TIMES DAILY, LONG-TERM
(AT LEAST 3 MONTHS IN OUR SETUP)
https://www.medicines.org.uk/emc/medicine/22505

15. HOW WE CAN HELP?
5) ANTIINFLAMMATORY TABLETS
TAB. BRUFEN FOR 10
DAYS
https://www.medicines.org.uk/emc/medicine/22505

16. HOW WE CAN HELP?
5) ANTIINFLAMMATORY TABLETS
TAB. PREDNISOLON WILL BE OF A LAST
HOPE IN HYPERSEVERE CASES (CONSULT
WITH THE OPHTHALMOLOGIST)
https://www.medicines.org.uk/emc/medicine/22505

17. HOW WE CAN HELP?
6) ANTIINFLAMMATORY EYEDROPS
DILUTED STEROID DROPS:
DEXAMETHASONE OR
PREDNISOLON
https://www.medicines.org.uk/emc/medicine/22505

18. HOW WE CAN HELP?
WHY DILUTE?
LESS CHANCES FOR:
STEROID CATARACT
STEROID GLAUCOMA
https://www.medicines.org.uk/emc/medicine/22505

19. HOW WE CAN HELP?
7) LID HYGIENE (CHECK FOR
BLEPHARITIS)

20. HOW WE CAN HELP?
8) TREAT OTHER ATOPIC DISEASES
(RHINITIS IN 20%, ASTHMA 27%,
ECZEMA 10%)
doi:10.1038/sj.eye.6700675

21. HOW WE CAN HELP?
9) HELMINTHS SCREENING (STOOL
ANALYSIS?), DEWORMING?
doi:10.1038/sj.eye.6700675

22. HOW WE CAN HELP?
SUMMARY:
1. SUN-GLASSES
2. COOL COMPRESSES
3. PIRITON TABLETS
4. BRUFEN TABLETS
doi:10.1038/sj.eye.6700675
5. SODIUM CROMOGLICATE DROPS
6. DILUTED STEROIDS DROPS
7. LID HYGIENE
8. TREAT CONCURRENT ATOPIC DISEASE
9. DEWORMING? STOOL ANALYSIS?

23. HOW WE CAN HELP?
UNFORTUNATELY, THE STATE-OF-THE-ART THERAPY
FOR SUCH SEVERE CONDITIONS IS NOT AVAILABLE
IN OUR SETUP:
TACROLIMUS AND CYCLOSPORINE EYE DROPS,
DEPO-MEDRONE AND TRIAMCINOLONE,
PENETRATING KERATOPLASTY ALL WILL GIVE
ADDITIONAL HOPE FOR THESE PATIENTS
doi:10.1038/sj.eye.6700675

24. HOW WE CAN HELP?
LET US TRY AND FOLLOW THE
PROTOCOL OF WHAT WE CAN
DO HERE

25. HOW WE CAN HELP?
SUMMARY:
1. SUN-GLASSES
2. COOL COMPRESSES
3. PIRITON TABLETS
4. BRUFEN TABLETS
5. SODIUM CROMOGLICATE DRO
6. DILUTED STEROIDS DROPS
7. LID HYGIENE
8. TREAT CONCURRENT ATOPIC D
9. DEWORMING? STOOL ANALYSI

26. THANK YOU
SEVERE CHRONIC ATOPIC
KERATOCONJUNCTIVITIS

27. SEVERE CHRONIC ATOPIC
KERATOCONJUNCTIVITIS
Challenging Eye Allergy Cases: How to Tackle?