ATYPICAL OCULAR ATOPY

Background: Atopic keratoconjunctivitis (AKC) is defined as a chronic keratoconjunctivitis associated with atopic dermatitis, but severe pro gressive keratoconjunctivitis as a sole manifestation of atopy also ma y occur. The authors report three patients with a longstanding history of chronic conjunctivitis with bilateral pannus formation. These pati ents denied any history of major atopy at the time of presentation. Me thods: All patients were evaluated for collagen vascular disease and f or evidence of atopy. Conjunctival biopsy was obtained in each case an d was analyzed by light microscopy and by immunohistochemical techniqu es. Results: Systemic evaluation for collagen vascular disease was neg ative. Serum IgE levels were elevated in one patient. Conjunctival bio psy suggested atopy in all patients with characteristic histopathologi c findings. Referral to an allergist showed wheal and flare reactions to multiple ubiquitous environmental allergens. Two patients then disc losed a history of atopic dermatitis and another confessed a history o f asthma. Each patient responded well to environmental control of alle rgens, topical cromolyn sodium 4%, and systemic antihistamine therapy with subsequent resolution of the chronic conjunctivitis. The corneal complications were managed with pannus resection and postoperative mit omycin C drops in two patients. Conclusion: These patients suffered fr om the progressive blinding consequences of a chronic keratoconjunctiv itis, which we believe is an atypical form of AKC. In this report, it is suggested that atopy should be considered in some cases of external ocular inflammation, even in the absence of the characteristic findin gs of systemic atopy. Conjunctival biopsy is a valuable diagnostic too l in such cases.