Blepharokeratoconjunctivitis in childhood: corneal involvement and visual outcome

Abstract

Purpose: The main objective of this study is to describe the prevalence, degree and risk of corneal involvement, and visual impact in a pediatric population with blepharokeratoconjunctivitis (BKC).

Methods: Retrospective, observational, case-control study. Clinical records of patients ≤16 years old with BKC seen between 2006 and 2012 were reviewed. The prevalence and relative risk of corneal involvement was evaluated between patients with and without corneal affection through a univariate and multivariate analysis with logistic regression. Visual acuity at presentation and at last follow-up visit was also analyzed.

Results: One hundred and fourteen children with BKC, with a male-to-female ratio of 1 : 1 and a mean age at diagnosis of 9.13 years. The mean follow-up time was 26.4 (±25) months. Corneal involvement was present in 39.5% of patients, varying from superficial punctate keratitis to perforation. Corneal changes were not seen in children under 4 years old. The risk of corneal affection was greater in patients with photophobia, hordeolum, female gender and asymmetric disease (OR of 2.69, 11.6, 2.35 and 2.77, respectively). The mean best-corrected visual acuity at presentation was 0.20 (corneal affected group), compared to 0.11 (unaffected group; P=0.02).

Conclusions: Our study showed an older age at time of diagnosis and a worse visual outcome in patients with BKC and corneal disease compared with previous reports. Early diagnosis and detection of risk factors for corneal involvement, as well as adequate treatment, is mandatory to prevent serious long-term visual repercussions in children with BKC.

Figure 1

Initial and final BCVA analysis of variance, comparing patients from the three groups: without corneal involvement, superficial punctate keratitis only, and corneal involvement.

Figure 2

(a) Left eye of a 12-year-old female with chronic BKC showing a dense inferotemporal leukoma that partially obstructs the visual axis; (b) left eye of a 9-year-old male showing a central stromal infiltrate with extensive neovascularization on all quadrants; (c) right eye of a 7-year-old female, seen 1 year after a corneal tectonic graft was performed owing to peripheral cornel perforation.