Clinical spectrum of pediatric blepharokeratoconjunctivitis.docx
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1、Clinical spectrum of pediatric blepharokeratoconjunctivitis Noopur Gupta, MS, DNB, Anuradha Dhawan, MS, FRCS, Sarita Beri, MD, and Pamela Dsouza, MS PURPOSE To evaluate the incidence, symptoms, clinical signs, and therapy instituted in children with blepharokeratoconjunctivitis (BKC). METHODS In thi
2、s observational, retrospective case series, we reviewed all medical records of pediatric patients presenting to the ophthalmology clinic at the Kalawati Saran Childrens Hospital, New Delhi, India from 2003 to 2006. History, clinical characteristics, and treatment protocol were noted, as well as reas
3、on for presentation/referral and subsequent diagnosis. RESULTS Of 5,012 pediatric patients, 615 (12%) demonstrated features of BKC. Boys were more commonly affected (62%) than girls. The mean age at presentation was 6.7 years (range, 7 months to 16 years). Lid involvement and conjunctival congestion
4、 were consistent fea- tures. Anterior (seborrheic variety) blepharitis was seen in nearly half the children (302), followed by chalazion (18%), external hordeolum (17%), ulcerative anterior blepharitis (6%), phlyctenular keratoconjunctivitis (6%), and marginal ulcerative keratitis (2%). Refractive e
5、rror was evident in 521 of 615 children (85%) with BKC. All patients were treated with daily eyelid hygiene, warm compresses, and topical antibiotics. Corticosteroid drops were prescribed in 14% and oral erythromycin in 23%. CONCLUSIONS BKC was the commonest diagnosis at consultation among all pedia
6、tric referrals. Anterior blepharitis was more common than posterior blepharitis. Severe cases with corneal involve- ment accounted for only 5% of the disease spectrum. ( J AAPOS 2010;14:527-529) B lepharokeratoconjunctivitis (BKC) is a chronic, in- BKC in an Indian pediatric cohort, 1,3,4 in terms o
7、f flammatory eyelid margin disease with secondary conjunctival and corneal involvement. It is a com- mon condition that is often underdiagnosed in children1,2 due to its numerous clinical variants. The clinical spectrum of the disease is varied, with findings ranging from inflamed eyelids, anterior
8、lid margin telangiectasia, accumulations of hard, fibrinous, and crusting scales (collarettes) around the base of the cilia, and, in severe cases, corneal involvement. BKC has previously been defined as “a syndrome usually associated with anterior or posterior lid margin blepharitis, accompanied by
9、episodes of conjunctivitis, and keratopathy including punctate erosions, punctate keratitis, phlyctenules, marginal keratitis, and ulceration.” 3 Indo-Pakistani and Middle Eastern children have been shown to be more seriously affected by this disease.3 To the best of our knowledge, the present study
10、 is the first to evaluate Author affiliations: Department of Ophthalmology, Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital, New Delhi, India The authors have no financial conflicts of interest to disclose. This work was presented at the 17th Annual Meeting of ASIA-ARVO
11、, Hyderabad, January 15-18, 2009. Submitted February 25, 2010. Revision accepted September 20, 2010. Published online November 22, 2010. Reprint requests: Noopur Gupta, MS, DNB, Department of Ophthalmology, Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital, New Delhi, Ind
12、ia 110001 (email: ). Copyright 2010 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/$36.00 doi:10.1016/j.jaapos.2010.09.013 demographics, clinical features, and treatment strategies. Patient and Methods In this noncomparative, noninterventional, retrospective case s
13、eries, we reviewed medical records of 5,012 pediatric patients (0-16 years) attending the ophthalmology outpatient department of Lady Hardinge Medical College and Associated Kalawati Saran Children Hospital from January 1, 2003 through March 31, 2006, noting the reason for presentation/referral and
14、subsequent diagnosis. The ethnicity of all patients cared for at our hospital was primarily Indian. The study conformed to the Declaration of Helsinki and our institutional review board confirmed that its approval was not required for this study. The diagnosis of BKC was based on the presence of the
15、 following features: tearing, photophobia, recur- rent episodes of red eye, blepharitis (recurrent external hordeo- lums or meibomian cysts), and/or keratitis. Morphologically, anterior blepharitis was divided into seborrheic (greasy, epithelial squames/flakes at the base of eyelashes) and ulcerativ
16、e (pustules, tiny ulcers, and/or hard crusts at the eyelid margin). Children with significant systemic disorders or a history of atopy, vernal keratoconjunctivitis, or perennial allergic conjunctivitis were excluded. Clinical symptoms and signs were graded as mild in case of lid margin disease; mode
17、rate if the conjunctiva was also involved; and severe in the case of corneal involvement according to the grading system described previously.3 We further noted the clinical characteristics and treatment strategies in all patients with BKC. Journal of AAPOS 527 Chronic discomfort 615 (100) Eye rubbi
18、ng 522 (84.8) Red eye 190 (30.9) Watering 246 (40) Diminution of vision 231 (35.6) Photophobia 44 (7.2) 528 Gupta et al Volume 14 Number 6 / December 2010 Results A total of 615 children (12.3%) were diagnosed with BKC; nearly half of these (47.5%) were bilaterally affected. The male:female ratio wa
19、s 1.6:1, with the average age at presen- tation being 6.7 years (range, 7 months to 16 years); 109 children with systemic disease or history of atopy/allergy were excluded. The presenting symptoms are given in Table 1; present- ing signs of the disease are delineated in Table 2. On clinical examinat
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