The Link Between Atopic Keratoconjunctivitis (AKC) and Atopic Dermatitis
Atopic keratoconjunctivitis (AKC) is a chronic allergic eye disease present in about <1-8% of the population. Although rare, this disease can have serious consequences, with the possibility of leading to vision loss. Those with AKC experience chronic inflammation to the surface of the eye as a result of a heightened immune response to allergens. AKC can sometimes be mistaken for an ocular allergy known as allergic conjunctivitis, whether seasonal (caused by allergens like pollen) or perennial (caused by allergens like dust mites or animal hair or dander). However, AKC affects more than just the conjunctiva (fragile membrane that makes up the outer surface of the eye and inside of the eyelid). With AKC, there is also involvement of the cornea (clear front surface of the eye). The persistent inflammation caused by this condition leads to corneal scarring and the formation of new blood vessels, which contributes to loss of vision.
The incidence of AKC increases when there is a family history of atopic disease, and can present along with the onset of other associated atopic conditions. Like AKC, atopic dermatitis (eczema) is an atopic disease that also co-occurs with other atopy-related diseases. Atopic dermatitis is categorized as a chronic and progressive skin disorder with symptoms of dry skin, itching, redness, thickened, cracked or scaly skin, and raw, sensitive, swollen skin from scratching. Though symptoms of atopic dermatitis primarily impact the skin, there is a relationship between the disorder and the growing number of eye complications associated with it, ranging between 25-50% of the cases. While only about 25-40% of patients with atopic dermatitis also present with AKC, atopic dermatitis is present in an estimated 95% of AKC cases. Due to this correlation, AKC is also known to have involvement of the eyelid in addition to the cornea. The eyelids exhibit signs of atopic dermatitis where they become red and very itchy, and eczema is frequently present on the skin surrounding the eye. The skin of the eyelids may also become dry, thickened and crusty. Other hallmark signs and symptoms of AKC include eye itching and redness, tearing/watery eyes, sensitivity to light, and mucous discharge. These signs and symptoms in conjunction with corneal involvement and the atopic dermatitis component are key factors in an AKC diagnosis.
Management and Treatment of Atopic Keratoconjunctivitis (AKC)
The first step in managing and treating AKC is having the correct diagnosis. Since there are several other forms of conjunctivitis, AKC should be properly differentiated from these other conditions. This is especially vital when the disease is associated with signs of a skin disorder (atopic dermatitis/eczema) as well. Even if atopic dermatitis patients are regularly seen by their dermatologist or allergist, they should also be evaluated by an ophthalmologist (eye specialist) regardless of the severity of their atopic dermatitis, since serious eye complications can still occur even with only mild skin changes. These eye changes can often progress very quickly, but if detected and diagnosed early enough, the appropriate treatment can be administered to avoid long-term damage.
Once a diagnosis of AKC has been confirmed, the aim is to reduce the inflammatory response and manage symptoms. Management of early disease takes a more conservative approach by treatment through cold compresses, lubricants, combination topical mast cell stabilizers and antihistamine eyedrops, to keep symptoms under control. As the disease progresses to a more advanced form, this approach is not as effective, and a more aggressive treatment option is needed. Therapy options include topical corticosteroid or cyclosporine drops and tacrolimus ointment applied to the skin of the eyelid. If these topical options don’t work, oral prednisone, tacrolimus or cyclosporine would be the next treatments targeted.
While therapeutic options do exist to manage advancement of disease, there are currently no FDA-approved treatments specifically for AKC. New systemic therapy options are needed, especially for patients whose disease is not responsive to the treatment options presently available. Without suitable treatment, corneal involvement can lead to irreparable vision loss. If you are experiencing the signs and symptoms representative of AKC, it is important to seek the care of an eye doctor so that they can monitor and manage your condition.
If you suffer from AKC and have not been able to successfully manage your signs and symptoms, even with help from your eye doctor, another option to consider is a clinical trial. Clinical trials are designed to find new and improved ways to detect, diagnose, treat and even prevent disease. Clinical trials can lead to medical advancements and their results can have a positive impact on the care and treatment of patients.
We are currently recruiting and enrolling participants in a clinical trial investigating a new treatment for atopic keratoconjunctivitis (AKC) / atopic dermatitis.