title: Medical Management of Blepharokeratoconjunctivitis in Children: A Delphi Consensus.
abstract: OBJECTIVE
  To describe a pragmatic approach to the medical management of blepharokeratoconjunctivitis in children, based on published evidence and clinical experience.
  
  
  METHODS
  The authors used the Delphi consensus method to explore the preferred management patterns of four senior clinicians at one institution to reach agreement on indications and dosage schedules for commonly used treatments. Four iterations were created, with electronic questionnaires distributed via an online survey platform. Initial questions were based on recent systematic reviews and clinical experience. After each round, a facilitator summarized the responses and fed these back to the expert participants, together with an invitation to complete the next round of questions.
  
  
  RESULTS
  Typical and specific eyelid, corneal, and conjunctival disease features influenced management decisions, and treatments were targeted toward specific findings in these tissues rather than to overall disease severity. Active keratitis was considered the main indication for high potency steroids, systemic antibiotics, and possibly systemic immunomodulators. Other indications for systemic antibiotics were chronic active blepharitis and recurrent troublesome chalazia. Oral antibiotics were used for their anti-inflammatory and antimicrobial properties. There was little agreement on the role of dietary modification, topical lubricants, and preference for oral or topical antibiotics.
  
  
  CONCLUSIONS
  Detailed clinical assessment of eyelids and ocular surface allows targeted treatment. Research is needed to clarify disease mechanisms and to optimize treatment strategies. [J Pediatr Ophthalmol Strabismus. 2017;54(3):156-162.].
authors.forename: Moritz Claudius
authors.initials: MC
authors.lastname: Daniel
authors.forename: Michael
authors.initials: M
authors.lastname: O'Gallagher
authors.forename: Melanie
authors.initials: M
authors.lastname: Hingorani
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Larkin
authors.forename: Stephen
authors.initials: S
authors.lastname: Tuft
authors.forename: Annegret
authors.initials: A
authors.lastname: Dahlmann-Noor
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001762:Blepharitis / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D032921:Consensus; D003697:Delphi Technique; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007637:Keratoconjunctivitis / Q000150:complications / Q000188:drug therapy*; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents