Pediatric Blepharokeratoconjunctivitis: An Update

Authors

  • Asim Ali, MD, FRCSC Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario

DOI:

https://doi.org/10.58931/cect.2024.3246

Abstract

Pediatric blepharokeratoconjunctivitis (BKC) is a form of ocular surface inflammation which is a unique clinical entity in children. It is also known as phlyctenular conjunctivitis and rosacea keratitis. A recent definition obtained with a modified Delphi method by a group of experts defined BKC as “a frequently underdiagnosed, sight‑threatening, chronic, and recurrent inflammatory eyelid margin disease associated with ocular surface involvement affecting children and adolescents. Its clinical spectrum includes chronic blepharitis, meibomitis, conjunctivitis, and corneal involvement, ranging from superficial punctate keratitis to corneal infiltrates with vascularization and scarring.” The pathophysiology of BKC is poorly understood but is believed to be related to staphylococcal hypersensitivity, with Staphylococcus aureus being the most common flora cultured from the lids in BKC. The robustness of the inflammatory response is thought to be age‑related. 

The age of onset of BKC is often as early as age 3–5 but can present in adolescence. Gender predilection varies between studies but is roughly equal in incidence for males and females. There is little good natural history data reported on the time course of the disease, but it can become chronic with multiple exacerbations over a period of years. In one study from the United Kingdom, there is the observation of increased incidence of severe disease in younger boys with South Asian or Middle Eastern background.2 In our experience, however, severe disease can present in all ages and ethnic groups. 

Author Biography

Asim Ali, MD, FRCSC, Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario

Dr. Asim Ali is the Ophthalmologist-in-Chief at the Hospital for Sick Children and Professor of Ophthalmology at the University of Toronto. He holds the endowed Mira Godard Chair in Vision Research and is Co-Director of the Paediatric Cornea Fellowship. He completed residency training at the University of Toronto and then dual fellowships in Paediatric Ophthalmology and Cornea at Washington University, St. Louis, USA. He focuses on complex anterior segment disorders in children with a special emphasis on corneal transplant, neurotrophic keratopathy and external disease. He is co-developer of the minimally invasive corneal neurotization procedure using sural nerve grafts. 

References

Nallely R, Morales-Mancillas NR, Velazquez-Valenzuela F, et al. Pediatric blepharokeratoconjunctivitis: A consensus for its definition and diagnostic classification criteria. The Pediatric Blepharokeratoconjunctivitis Study Group. JAMA Ophthalmology. Jan 2024; 142(1):39-47. DOI: https://doi.org/10.1001/jamaophthalmol.2023.5750

Viswalingam M, Rauz S, Morlet N, et al. Blepharokeratoconjunctivitis in children: diagnosis and treatment. Br J Ophthalmol. 2005;89(4):400-3. DOI: https://doi.org/10.1136/bjo.2004.052134

Hamada S, Khan I, Denniston AK, et al. Childhood blepharokeratoconjunctivitis: characterising a severe phenotype in white adolescents. Br J Ophthalmol. 2012;96(7):949-55. DOI: https://doi.org/10.1136/bjophthalmol-2011-300771

Choi DS, Djalilian A. Oral azithromycin combined with topical anti-inflammatory agents in the treatment of blepharokeratoconjunctivitis in children. J AAPOS. 2013;17(1):112-3. DOI: https://doi.org/10.1016/j.jaapos.2012.10.015

Doan S, Gabison EE, Nghiem-Buffet S, et al. Long-term visual outcome of childhood blepharokeratoconjunctivitis. Am J Ophthalmol. 2007;143(3):528-9. DOI: https://doi.org/10.1016/j.ajo.2006.09.058

Moon J, Lee J, Kim MK, et al. Clinical characteristics and therapeutic outcomes of pediatric blepharokeratoconjunctivitis. Cornea. 2023;42(5):578-83. DOI: https://doi.org/10.1097/ICO.0000000000003120

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Published

2024-06-18

How to Cite

1.
Ali A. Pediatric Blepharokeratoconjunctivitis: An Update. Can Eye Care Today [Internet]. 2024 Jun. 18 [cited 2024 Jul. 24];3(2):47–50. Available from: https://canadianeyecaretoday.com/article/view/3-2-ali

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