Visual outcome and corneal changes in children with chronic blepharokeratoconjunctivitis.
OBJECTIVE
To describe the cause, management, and effect of chronic blepharokeratoconjunctivitis (BKC) on the cornea and visual function in children.


METHODS
Noncomparative, interventional, retrospective case series.


METHODS
Twenty-seven children with BKC.


METHODS
Presenting age, best-corrected visual acuity (BCVA), refractive error, and any corneal or eyelid pathologic features were recorded. Treatment included modified lid hygiene, topical antibiotics, and steroids. Systemic therapy included oral antibiotics and, from 2003 onward, flaxseed oil as an alternative to long-term antibiotics. Amblyopia therapy included refractive correction, occlusion, or atropine therapy.


METHODS
Corneal and eyelid status, visual acuity (VA), and refractive error at final examination.


RESULTS
Mean age at presentation was 6.9 years (range, 7 months-15.9 years), and mean follow-up was 2.3 years (range, 5 months-6.1 years). All patients had discomfort, conjunctival injection, and signs of posterior blepharitis at presentation. Photophobia was reported in 14 patients (52%), whereas anterior eyelid inflammation was noted in 6 (22%). Acne rosacea was confirmed in 3 patients (11%). Corneal involvement occurred in 44 eyes (81%), and a history of recurrent chalazia was seen in 18 patients (67%). Median monocular BCVAs in affected eyes were 0.28 logarithm of the minimum angle of resolution (logMAR) units (interquartile range [IqR], 0.02-0.40) at presentation and 0.02 logMAR units (IqR, 0.00-0.18) at last visit. Best-corrected VA improved in 70% of affected eyes and remained unchanged in 30%. Superimposed amblyopia was present and treated in 15 patients (48%). All 8 patients (20%) who failed to achieve VA of 0.2 logMAR units or better at the final examination had bilateral corneal involvement at presentation. One child experienced a systemic side effect from oral antibiotics. No child had significant side effects from topical treatment. Twelve patients (44%) received flaxseed oil as part of their tapering regimen. A 2-year lag between symptom onset and treatment resulted, on average, in a reduction of 0.06 logMAR units of VA (95% confidence interval, 0.00-0.12; P = 0.054).


CONCLUSIONS
These findings suggest that visual loss may be significant in BKC and that delayed treatment may result in decreased final BCVA. Adequate management needs both topical and systemic treatment. Flaxseed oil may be an effective antiinflammatory nutritional therapy alternative to long-term antibiotics.
Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom.
Sophie M
SM
Jones
Joel M
JM
Weinstein
Phillippa
P
Cumberland
N
N
Klein
Ken K
KK
Nischal
D000293:Adolescent; D000550:Amblyopia / Q000503:physiopathology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001762:Blepharitis / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003315:Cornea / Q000503:physiopathology*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007637:Keratoconjunctivitis / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D012030:Refractive Errors / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D014786:Vision Disorders / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids