Ceratoconjuntivite Atópica: aspectos clínicos

Abstract

Introduction: Atopic keratoconjunctivitis (AKC) is a chronic allergic eye disease that occurs most frequently in adults with a history of atopic dermatitis (AD). Although less common than other forms of eye allergies, AKC can cause severe damage to the ocular surface, leading to corneal scarring and vision loss if not treated properly. It usually begins in late adolescence or early adulthood, with a peak incidence between 30 and 50 years of age. Personal and family histories are almost always positive for atopy (more commonly AD and asthma than allergic rhinitis). Objectives: discuss clinical aspects and initial management of atopic keratoconjunctivitis. Methodology: Integrative literature review based on scientific databases from Scielo, PubMed and VHL, from January to April 2024, with the descriptors “Atopic keratoconjunctivitis”, “Clinic” AND “Diagnostic”. Articles from 2019-2024 (total 38) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: The most commonly reported symptom of AKC is severe itching, which usually occurs perennially, although some patients report seasonal exacerbations. Tearing, burning, clear mucus discharge, and redness are also almost always present. Other symptoms include blurred vision, photophobia, and foreign body sensation. Most patients rub their eyes incessantly. Chronic inflammation of the ocular surface can lead to vision loss. AKC may involve the eyelid, conjunctiva, and cornea; There is a wide range of severity, from mild, isolated eyelid involvement to vision-threatening corneal involvement. Both eyes are usually involved, although the severity may be asymmetrical. On physical examination, it is possible to find thick eyelids; intermittent swelling of the eyelids due to chronic inflammation; scaly, hardened appearance on periocular skin, with scaly dermatitis and a reddish base. AKC should be suspected in a patient with a history of AD who presents with ocular itching and eyelid dermatitis. Referral to an ophthalmologist should be sought in all patients with suspected AKC, regardless of severity. Diagnosis is based on typical epidemiological and clinical characteristics. Routine laboratory tests are not useful and there are no established diagnostic criteria. The approach for patients with AKC includes basic eye care, topical medications, and systemic medications if necessary. We suggest a dual-acting topical antihistamine stabilizer as first-line therapy. Additional therapies should only be initiated in consultation with an ophthalmologist. Conclusion: Atopic keratoconjunctivitis (AKC) is a chronic and aggressive form of ocular allergy that occurs most frequently in adults with a history of atopic dermatitis (AD). If not treated properly, AKC can damage the surface of the eye, leading to corneal scarring, keratoconus due to persistent friction in the eyes, and loss of vision.