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    Systematic approach key for treating pediatric atopic keratoconjunctivitis

    Calcineurin inhibitors may reduce conjunctival inflammation in pediatric eyes

    Take-home: Pediatric patients with atopic keratoconjunctivitis affecting the eyes may best be treated with topical calcineurin inhibitors to decrease the conjunctival inflammation.

    Reviewed by Stephen Pflugfelder, MD

    HoustonWhen faced with challenging pediatric cases of atopic keratoconjunctivitis, a treatment strategy based on disease severity may be the most beneficial, said Stephen Pflugfelder, MD.

    “It is fine to start treatment with antihistamines and mast cell stabilizers and then prescribe topical corticosteroids, with dose adjustments based on disease severity,” said Dr. Pflugfelder, professor of ophthalmology, Baylor College of Medicine, Houston. “However, children cannot be treated with high-dose topical steroids over the long term.

    More in this issue: Early intervention considered key in diagnosis and treatment of scleritis

    Dr. Pflugfelder, MD, shared some clinical pearls for treating a patient with persistent ocular redness and eyelid swelling. In one case, an 11-year-old boy presented with a history of ocular redness of several years duration, tearing, and itching. Most recently, the boy complained of difficulty seeing the board at school. His mother reported eyelid swelling.

    The patient was healthy with the exception of asthma that was controlled. Treatment of the redness with olopatadine drops (Patanol, Alcon Laboratories) resulted in minimal benefit. Symptom improvement did occur with prednisolone acetate.

    Bilateral best-corrected visual acuity was 20/50. Examination showed mild swelling of the upper eyelids and edematous inferior puncta. Tears overflowed from the inferior tear meniscus. The eyelids had a velvet papillary reaction and thickened inferior and superior palpebral conjunctiva. A vortex pattern of fluorescein staining was seen from the superior limbus to the central cornea in both eyes.

    Click for more atopic keratoconjunctivitis news

    While no dermatitis was present on the child’s head and face, dermatitis was present in the antecubital fossa on both arms.

    Next: Case management

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