Anterior Segment
Atopic Keratoconjunctivitis
Also known as: AKC, atopic conjunctivitis, adult allergic keratoconjunctivitis, eczema eye, atopic dermatitis eye, chronic allergic conjunctivitis adult, keratoconus atopic, herpes atopic eye
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A chronic, severe bilateral allergic keratoconjunctivitis affecting adults with atopic dermatitis. Unlike VKC (which resolves in adulthood), AKC is a lifelong condition in predisposed individuals. Carries significant risk of corneal scarring, keratoconus, cataract, and secondary herpetic infection. Requires specialist co-management.
Recognition
Symptoms: what patients report
- Chronic bilateral itching — less dramatic than VKC but persistent throughout the year.
- Burning and foreign-body sensation.
- Mucopurulent or stringy discharge.
- Photophobia when the cornea is involved.
- Reduced vision in advanced disease (corneal scarring, keratoconus, or cataract).
- Associated severe atopic dermatitis of the periocular skin — eczematous, lichenified, thickened eyelid skin.
- History of atopy: eczema, asthma, or allergic rhinitis since childhood.
Signs: what the examination shows
- Eczematous, lichenified periocular skin — thickened, scaly, fissured eyelid skin.
- Papillary conjunctival reaction (upper and lower tarsal plates — unlike VKC which predominantly affects the upper tarsal plate).
- Fornix shortening and conjunctival scarring (symblepharon) in advanced or long-standing disease.
- Corneal neovascularisation, scarring, and opacity in severe cases.
- Keratoconus — cone-shaped corneal deformity from chronic rubbing.
- Posterior subcapsular cataract — from chronic steroid use or the disease itself.
- Staphylococcal blepharitis commonly co-exists.
What OptoGuide™ covers for atopic keratoconjunctivitis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Atopic keratoconjunctivitis (AKC) — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Mucous Membrane Pemphigoid and Pseudopemphigoid. Thorne JE, Anhalt GJ, Jabs DA. Ophthalmology. 2004;111(1):45-52.
- Atopic Keratoconjunctivitis: A Review. Chen JJ, Applebaum DS, Sun GS, Pflugfelder SC. Journal of the American Academy of Dermatology. 2014;70(3):569-75.
- Ocular Co-Morbidities of Atopic Dermatitis. Part I: Associated Ocular Diseases. Beck KM, Seitzman GD, Yang EJ, Sanchez IM, Liao W. American Journal of Clinical Dermatology. 2019;20(6):797-805.
- Seeing eye to eye: a modified Delphi method-based multidisciplinary expert consensus on the therapeutic management of vernal keratoconjunctivitis — Eur J Pediatr 2024 (the stepwise ladder including the corticosteroid rung)
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.