Oral erythromycin treatment for childhood blepharokeratitis

Blepharokeratitis is a chronic external ocular and adnexal inflammatory con dition marked by erythematous and edematous lid margins, lid margin crustin g and scaling, meibomian gland inflammation and inspissation, and conjuncti val hyperemia. The associated keratitis usually involves the inferior corne a and is characterized by punctate epithelial keratopathy and marginal stro mal infiltrates. The inflammation sometimes leads to corneal thinning, scar ring, and vascularization. The standard therapy for adult blepharokeratitis includes lid hygiene, topical corticosteroid preparations, and topical ant ibiotics. Oral tetracycline and its analogues, doxycycline and minocycline, are used in adults to treat associated meibomian gland dysfunction. Wherea s blepharitis is common in children, blepharokeratitis is rare and is often associated with severe ocular and psychosocial morbidity. Treatment of you ths may be problematic because of poor compliance with lid hygiene and ther apy that includes drops and ointment.(1) Furthermore, the use of tetracycli ne and its analogues is contraindicated in children aged less than 8 years because it may cause dental enamel abnormalities. Isolated case reports hav e suggested that erythromycin may be a reasonable alternative to tetracycli ne in childhood blepharokeratitis.(2,3) We report on the successful treatme nt of this condition with oral erythromycin in 5 children.