Blepharokeratoconjunctivitis in children: diagnosis and treatment.

AIM: Blepharokeratoconjunctivitis (BKC) is a poorly described entity in children. This study characterises this syndrome in childhood and evaluates epidemiology, clinical grading, and treatment strategies. METHODS: 44 children (20 white, 22 Asian, 2 Middle Eastern, median age 5.4 (range 1-14) years) with a diagnosis of BKC were followed for a median of 7 years. Diagnostic criteria included recurrent episodes of chronic red eye, watering, photophobia, blepharitis including recurrent styes or meibomian cysts, and a keratitis. Clinical features were graded as mild, moderate, or severe. The lids and conjunctiva were cultured. The treatment regimen incorporated lid hygiene, topical and/or systemic antibiotics, and topical corticosteroids. RESULTS: The disease was most severe in the Asian and Middle Eastern children (p <0.001), who had a statistically higher risk of subepithelial punctate keratitis (p = 0.008), corneal vascularisation (p <0.001), and marginal corneal ulcerations (p = 0.003), than the white group. 15 children had culture positive lid swabs. Most children had a reduction in symptoms and signs with treatment, and progression of disease after the age of 8 was rare. CONCLUSIONS: BKC in children can be defined as "a syndrome usually associated with anterior or posterior lid margin blepharitis, accompanied by episodes of conjunctivitis, and a keratopathy including punctate erosions, punctate keratitis, phlyctenules, marginal keratitis, and ulceration." BKC is common in children in a tertiary referral corneal and external diseases clinic, with the more severe manifestations in the Asian and Middle Eastern populations. Therapy is effective and loss of sight can be prevented in most cases.

Acute follicular conjunctivitis and keratoconjunctivitis due to herpes simplex virus in London.

During the 18 months January 1975 to June 1976, 25 cases of acute herpetic follicular conjunctivitis and keratoconjunctivitis resembling adenovirus ocular infection presented in the External Eye Disease Clinic, Moorfields Eye Hospital, City Road, London. Herpes simplex virus was isolated in HEp2 cells in 22 patients, and the remaining 3 patients were identified by a minimum 4-fold rise in the level of antiherpes simplex virus antibody in their blood. No adenovirus was isolated from these patients, but complement fixation test for adenovirus was positive in 1 patient with cultural test positive for herpes simplex virus. Most patients were between 20 and 35 years old and the ratio of males to females was 12 to 13. At the initial visit the clinical features of disease were moderate to severe conjunctival papillary and follicular reasons with epithelial and subepithelial punctate keratitis but little systemic disease. In the absence of typical herpetic lesions of face, lids, or cornea the disease resembled adenovirus types 8 or 19 keratoconjunctivitis. Of these 25 patients 5 subsequently developed typical herpetic lesions of lids or cornea. In the remaining 20 cases the correct diagnosis could be made only by cultural or serological tests. Virological diagnosis provides a rational basis for antiherpetic chemotherapy, which appears to shorten the course of infection.

Isolation of Chlamydia psittaci from a patient with interstitial keratitis and uveitis associated with otological and cardiovascular lesions.

A case history of a 15-year-old schoolgirl with fluctuating bilateral uveitis, bilateral stromal keratitis with vascularisation, and bilateral deafness associated with tinnitus and balance disturbance is described. Three years from the onset of her clinical signs she died of a sudden cardiac arrest caused by endocarditis associated with valvular and arterial lesions. Chlamydia psittaci was isolated from her conjunctiva. In her blood type-specific antichlamydial antibody at a level of 1/64 against her own isolate was detected. The clinical findings in this patient were suggestive of a Cogan's syndrome. It is highly probable that the chlamydia isolated from the eyes was responsible for her various lesions.

Treatment of TRIC infection of the eye with rifampicin or chloramphenicol.

An open trial was carried out on 63 patients in London to assess the efficacy of 1% rifampicin eye ointment in comparison with 1% chloramphenicol eye ointment in the treatment of sexually transmitted TRIC infection of the eye. Patients included were selected on the basis of positive cultures for Chlamydia trachomatis. Three weeks' treatment with rifampicin eye ointment used 3 times daily was not sufficient to cure the disease, but a 6 or 7 week course gave 90% clinical and microbiological cure rate. Treatment with chloramphenicol eye ointment 3 times daily for 4 to 6 weeks failed to cure the disease.