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Atopic keratoconjunctivitis and atopic dermatitis

Guglielmetti, Stefano; Dart, John KG; Calder, Virginia

Current Opinion in Allergy and Clinical Immunology: October 2010 - Volume 10 - Issue 5 - p 478–485
doi: 10.1097/ACI.0b013e32833e16e4
Eye allergy: Edited by Leonard Bielory and Stefano Bonini

Purpose of review This review will focus on the diagnostic features of atopic keratoconjunctivitis (AKC), its relationship to atopic dermatitis, the immunopathogenesis, and therapy, and will include strategies used for the management of severe disease unresponsive to conventional therapy.

Recent findings Recent research has demonstrated the importance of various cytokines (IL-33), proteins (thymic stromal lymphopoetin) and effector cells (conjunctival epithelial cells, eosinophils and basophils) in the pathogenesis of chronic ocular inflammation. Current evidence supports the use of tacrolimus and cyclosporin A, topically or systemically, as well tolerated and effective steroid sparing agents.

Summary Recalcitrant AKC may be a blinding condition. Understanding the immunopathogenesis of atopic dermatitis and AKC has already influenced therapy and is essential to the development of future immunomodulatory treatments. The successful management of AKC requires the use of topical cromones, antihistamines and calcineurin inhibitors. Severely affected patients also require systemic immunosuppressive therapy. The current challenge is to find more specific topical and systemic immunomodulatory therapies with a better side-effect profile.

aMoorfields Eye Hospital, NHS Foundation Trust

bCorneal & External Disease Service, Moorfields Eye Hospital

cUCL Institute of Ophthalmology

dDepartment of Ocular Biology & Therapeutics, UCL Institute of Ophthalmology, London, UK

Correspondence to John K.G. Dart, MA, DM, FRCOphth, Consultant Ophthalmologist, Corneal & External Disease Service, Moorfields Eye Hospital, 162 City Road, London EC1 V 2PD, UK

Copyright © 2010 Wolters Kluwer Health, Inc. All rights reserved.