Atypical ocular atopy.
BACKGROUND
Atopic keratoconjunctivitis (AKC) is defined as a chronic keratoconjunctivitis associated with atopic dermatitis, but severe progressive keratoconjunctivitis as a sole manifestation of atopy also may occur. The authors report three patients with a longstanding history of chronic conjunctivitis with bilateral pannus formation. These patients denied any history of major atopy at the time of presentation.


METHODS
All patients were evaluated for collagen vascular disease and for evidence of atopy. Conjunctival biopsy was obtained in each case and was analyzed by light microscopy and by immunohistochemical techniques.


RESULTS
Systemic evaluation for collagen vascular disease was negative. Serum IgE levels were elevated in one patient. Conjunctival biopsy suggested atopy in all patients with characteristic histopathologic findings. Referral to an allergist showed wheal and flare reactions to multiple ubiquitous environmental allergens. Two patients then disclosed a history of atopic dermatitis and another confessed a history of asthma. Each patient responded well to environmental control of allergens, topical cromolyn sodium 4%, and systemic antihistamine therapy with subsequent resolution of the chronic conjunctivitis. The corneal complications were managed with pannus resection and postoperative mitomycin C drops in two patients.


CONCLUSIONS
These patients suffered from the progressive blinding consequences of a chronic keratoconjunctivitis, which we believe is an atypical form of AKC. In this report, it is suggested that atopy should be considered in some cases of external ocular inflammation, even in the absence of the characteristic findings of systemic atopy. Conjunctival biopsy is a valuable diagnostic tool in such cases.
Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston 02114.
Y A
YA
Akova
N S
NS
Jabbur
R
R
Neumann
C S
CS
Foster
D000328:Adult; D000368:Aged; D001249:Asthma / Q000473:pathology; D001706:Biopsy; D002908:Chronic Disease; D003228:Conjunctiva / Q000473:pathology; D003233:Conjunctivitis, Allergic / Q000188:drug therapy / Q000276:immunology / Q000473:pathology*; D003320:Corneal Ulcer / Q000473:pathology; D004205:Cromolyn Sodium / Q000627:therapeutic use; D003876:Dermatitis, Atopic / Q000473:pathology; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D008875:Middle Aged
D006633:Histamine Antagonists; D007073:Immunoglobulin E; D004205:Cromolyn Sodium