Case Presentation:
Atopic
Keratoconjunctivitis
Initial Presentation

20 y/o M presents with c/c of bilateral erythema to eyes x1 month.
Describes onset as sudden with only redness at first, but progressed to
include pruritis and foreign body sensation (feeling of "rocks in my eyes").
Denies any discharge or excessive tearing but does endorse occasional
difficulty opening eyes upon waking and feeling the need to clean the
eyes in order to open them upon waking. Patient is experiencing a 2/10
intermittent stabbing grittiness to bilateral eyes. Has tried Refresh eye drops
(first received 03Jun) with some relief of symptoms, no other
relieving/aggravating factors. Has been told that his redness appears to
worsen mid-morning/early afternoon, but no other temporal factors.
Denies any contact with sick coworkers, denies any previous history of
similar symptoms or seasonal allergies. No family history or personal history
of atopy (to include asthma, eczema, psoriasis). Denies further concerns.
Review of Systems

All benign with the following exceptions:

Patient endorses mild photophobia with movement from dark to light, mild eye
discomfort, occasional blurry vision. Denies diplopia. Does not use corrective
lenses. Denies eye pain. Denies changes in visual acuity.
Physical Examination/Special Tests
Picture (1)


All benign with the following exceptions:

3+ temporal injection with chemosis, 2+
nasal OD

2+ nasal injection with chemosis, 1+
temporal OS
Special Test – Fluorescein Stain

Picture (2)
No signs of corneal abrasion
Treatment Plan

Pred Forte 1% ophthalmic suspension, TID x7days

Follow up in 1 wk for re-evaluation with Optometry; if improved may
consider taper to complete regimen, or may consider continued therapy
for an additional 1-2 weeks.
Why AKC instead of just allergic
conjunctivitis?

AKC is a sub-type of allergic conjunctivitis
(more specific diagnosis)

AKC generally presents with no
discharge, vs watery clear discharge with
allergic conjunctivitis

There is marked corneal edema involved
with AKC
This patient presented with no personal hx of
atopy, which usually is a hallmark
Picture (3)
Sources

Pictures:

(1)
https://www.semanticscholar.org/paper/Limbitis-Secondary-to-AutologousSerum-Eye-Drops-in-WelderBakhtiari/8c909201db0ea038ed05df91e5c7f1fa75c5591b/figure/0

(2)
https://www.semanticscholar.org/paper/The-evaluation-of-bulbar-rednessgrading-scales-Schulze/3a9e60459d4c4f6942d6ddc274e6ff8075392bc4

(3)
https://www.jacionline.org/article/S0091-6749(04)03032-5/fulltext