Atopic Keratoconjunctivitis
Atopic keratoconjunctivitis (AKC) is a severe form of allergic eye disease that tends to worsen and then have periods of remission. AKC can sometimes be worse in the winter. AKC often affects people younger than 20 years of age and is more common in males than in females. These people usually complain more about their eyes burning instead of itching.
People with AKC often have a history of skin conditions or dermatitis such as eczema. Some people with AKC suffer from eczema around their eyes and eyelids. The allergic reaction can be so severe that the conjunctiva, the inside lining of the eyes and eyelids, develop thickening and scarring. Your eye doctor may see additional signs of AKC, such as new blood vessel growth within the cornea, the clear, dome-like structure on the front part of your eye. Infiltrates, small white spots that are made up of inflammatory material and white blood cells may also develop in the cornea.
A corneal condition called keratoconus is also sometimes found in people with AKC. Keratoconus is a slow-developing condition in which the cornea becomes extremely steep. The cornea also becomes very thin, causing significant changes in vision, scarring, and distortion of the cornea. Although keratoconus is thought to be inherited, some believe that keratoconus is actually caused by the intense “rubbing of the eye” associated with severe forms of eye allergies.
Vernal Keratoconjunctivitis
Vernal keratoconjunctivitis (VKC) also affects younger people, usually males between the ages of 7 and 21. VKC tends to be more common in warmer areas of the country. Unlike AKC, which may have more burning than itching, the main symptom of VKC is a severe, unrelenting itch.
People with VKC often have a white, ropy discharge and appear to have ptosis, a condition in which the eyelids hang down lower than normal. The underside of the eyelids will also have large bumps called papillae and redness. Doctors may refer to it as looking like a cobblestone appearance. VKC can also cause a unique reaction called Horner-Trantas Dots, which are small bumps of inflammatory cells around the limbus, the tissue located at the edge of the cornea. One very important concern for people with VKC is the development of shield ulcers on the cornea. The body develops shield ulcers in reaction to the cobblestone bumps under the eyelid and from the over-reacting immune system.
Treatments
If you wear contact lenses and are suffering from severe eye allergies, it is recommended that you discontinue wearing them and see an eye doctor for proper diagnosis and treatment. Although most people who wear contact lenses and develop these diseases have already given up their contact lenses, it is thought that contact lenses can worsen the allergic response.
Corticosteroid eye drops are usually prescribed to acutely control the allergic reaction. Antihistamine eye drops are also prescribed. Antihistamines and mast-cell stabilizers are used as preventive measures for both conditions; mast-cell stabilizers are particularly effective in controlling VKC. Restasis, a drug most commonly prescribed for the treatment of dry eye syndrome, is sometimes used as it is considered safer than steroids for long-term treatment.
In some cases, steroids can cause unwanted serious side effects, such as cataracts and glaucoma. If a shield ulcer develops, antibiotics are prescribed to prevent infections. You may be co-managed with an allergy doctor for skin and systemic treatment. If the skin around your eyelids is inflamed, non-preserved steroid ointments may be prescribed. Some people tend to be very sensitive to preservatives found in some medications.
Allergen immunotherapy (allergy shots) can also be are extremely effective for allergen conjunctivitis in general, including AKC and VKC.
A Word From Verywell
Eye allergies are common, especially during the warmer months. However, sometimes eye allergies can develop into more serious conditions. If your seasonal eye allergies seem to develop more intense symptoms, see your eye doctor.
